I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: marlinfshr on January 14, 2014, 01:27:16 PM
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I had been waiting for medicare as I trully believed it would be a good policy. My social worker recommended me waiting to apply because my insurance, which I had last year, was covering everything and my OOP max had been met. I wasn't paying a dime and saw all my monthly explanation of benifits from my insurance in which all was marked "PAID".
Now comes medicare in which I was approved for back in November. Of course I was approved going back to August 1st. I also got a medigap "plan A" as that is all that is available for me in MD, and a part D drug plan. So as Of January 1st I am completely on medicare/medigap and am now confirmed on the transplant list. Though inactive until my year on plavix has passed.
Now comes today in which I received a summery of medicare going back to August 1st. It showed that they were billed and payed they're agreed on amount and that I can be billed another $3000 plus my 2013 deductible of 140 something. Does this sound right? I had insurance for that whole time and everything was payed by my insurance company until the end of the year when I had that policy changed to a medigap starting this January. Finally I was unstressed and thought I was on track of moving out of this hole when this damn medicare crap sends this to me. I don't see how anybody can truly get out of this mess as I am now expecting a bill for another 3 grand which I don't have----unless I sell my house, truck and everything else I own just to cover these damn bills that will soon be coming for things my insurance company already paid for.
Any advise? Am I overreacting? I mean, how can I forward this to my insurance company as I no longer have last years policy? Is this normal for medicare to do this. It said its's not a bill but clearly stated that I may be billed for the other 3 grand which is above the medicare agreed on price. It also said I have met my 2013 deductible.
I was adamant as well upon applying for medicare that I didn't need nor want it until January 1st as my insurance at the time was very good for my dialysis.
Oh well, back to being completely stressed out so I'll probably have another heart attack. F'n medicare. I thought it was supposed to be good for us. Boy was I wrong. Now, can I cancel it and go with a real insurance policy? I was under the impression we needed to go on it unless we were covered by a company policy in which of course I'm not because I haven't been working due to this crap and my line of work never offers anything anyways.
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Does not sound right. If you had medicare and a private policy, both should pay. One will be primary and one will be secondary and pick up coverage uncovered by the primary. As to which one is primary or secondary depends on the source of the private policy. If its employer insurance then it is primary initially. If its an individual policy(non employer) then medicare is primary and your private policy is secondary and should pay what medicare does not. If you get any bills not covered by medicare submit them to your private policy even though you no longer have it. The key is you were covered by it when you were being treated last year.
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The Medicare statements [EOB] always say 'you may be billed'. You won't be because your private ins. picked it up !!My hubbies bills were over 35,000 last year, lots of the Medicare statements had amounts left on them, at first I freaked out !!! But I logged into his other ins. plan, and discovered all those 'you may be billed' amounts were paid by them. Medicare gets the bill first, so they don't know if the rest will be covered when they send out statements. Take Care.
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Thanks for the reply's. I feel a little better now. I posted that while I was in pure panic mode right after opening the envelope.
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Totally understandable. Unfortunately for me, I had no viable private policy when I started. I got my gap policy and prescription D going December 1st. I am juggling bills for the 20% and for catheter and fistula surgery and dialysis going back to September. Its thousands of dollars for just 3 months. I am now the proud owner of a cardboard sign that says will work for food. I feel so much better after being on dialysis since 9/27/13. The money issues will take care of themselves I hope. I am supposed to meet with the social worker next lab day to make a plan.
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The rest will be picked up by secondary insurance. Until you receive a bill from the dr, do not stress too much.