I need help - Medicare Primary / Employer Secondary

[The_Vincester]

After my 30 coordination period ended a d Medicare became my primary, my employer insurance has been nothing but screwy. They don't seem to know the rules or who pays what and gave me horrible advice when it was time to renew for the year.

Sometimes it's the different facilities I've gone to, charging the wrong people. To make things more confusing, my employer insurance has payed things they shouldn't have, and continued to be billed, then decide not to pay it.

Now I'm at a new year in the plan and they moved me to a high deductible (everyone - not just me).  So now all of my mess are running out and it seems I have costs piling up that I didn't have before.

My transplant was June of last year. Up to that point, my medicine was reasonable - my employer payed for most and medicare picked up the rest it seems. Since I had medicare, they pay 80% of my immunosuppresent drugs currently - but 20% of $1300 is still a lot. What I don't know is - what is the responsibility
of my employer insurance? I have a $4500 deductible. Does I really have to go that much for them to pick up that 20%? That seems pretty crazy since I play full premiums for someone else to be primary. Two sets of premiums (part B) and I still have this much out of pocket cost?!

The thing is - NO ONE at my insurance company can give me an answer... or at least the same one twice in a row.

Here's the real kicker - my employer IS the insurance company in question.

[Bill Peckham]

You had a Tx in June but you've been using dialysis for 33 months? (there is a three month lag before the 30 month clock starts)


 Not sure why you would be Medicare primary.