Hypothetical About Medicare

[PrimeTimer]

Here is a hypothetical question: Regardless as to whether or not Medicare has actually been paying as your Primary insurance provider, can your employer insurance (or private insurance) move themselves into "secondary" position and reduce the amount they pay on claims because you are simply "eligible" for Medicare? 

Put another way: I realize coverage on employer and/or private plans vary but are they allowed to stop coverage or reduce their coverage based on your eligibility to have Medicare as your primary? Or must they wait until Medicare has actually paid as your "primary"? Seems to me eligibility and actually receiving benefits are two different things. I would think that just because you are eligible for Medicare does not mean Medicare has actually paid anything.

[MooseMom]

I am under 65 and became eligible for Medicare once I was txed.  My husband's employer based insurance covered everything and still does.  I have never used Medicare.  In fact, within all of the bumph Medicare sent me, there was one teensy paragraph that advised checking with your existing ins first, and that is exactly what I did.

Is someone giving you the run around?

[PrimeTimer]

Long story short, my husband's employer insurance moved themselves into "secondary" position based on his "eligibility" to receive Medicare but before Medicare actually started paying out benefits as his primary. Fresenius wants their money. Meanwhile, based on a letter he got from Medicare, he paid them $1500 in addition to his monthly premium to back date his eligibility. Well, they didn't lose the check but they lost the letter. Without the letter, they didn't know what to do, so they cashed his check and applied it future premiums. Meanwhile, Fresenius calls and calls wanting their money. Hubby took the day off to deal with Medicare and was prepared to give them another $1500 check to make his coverage retroactive. But...Medicare said that since it's been 60 days since my husband received the letter from them, he can't pay them another $1500 to make his coverage retroactive. The girl just shrugged her shoulders and said "that's it's. Nothing more can be done" and that was that.  Funny, they didn't have permission to apply that money to future premiums...even funnier is that they wouldn't take more money from him today. But it's interesting that his employer insurance stopped paying their 80% without proof that Medicare was paying 20% or anything for that matter. Funny how these companies and govt agencies get to base their decisions on things that haven't actually happened or without people's permission. They simply base their decisions on that word "eligibility" and not the actual proof that benefits are being paid. And oh yeah...Fresenius calls and calls...and calls and calls...everybody seems to know the other's job and yet, no one is doing anything. Round, round we go and when the madness stops nobody knows! So he took the day off and tried to give Medicare another $1500 but they didn't want it. How we are going to explain this to Fresenius we haven't a clue but we've agreed that we are not paying them another dime beyond what they are already getting from Medicare and the employer insurance. Bizarro world indeed!

[cassandra]

Completely ridiculous. There I was thinking how ridiculous it was here in the UK (concerning changing a prescription for example, I wouldn't dare complain about OUR NHS........)


Good luck with this PT


Love, Cas

[Michael Murphy]

First thing to do is contact the insurance person at Fresinius who covers your clinic.  They have a specialist to help with problems like this.  Two other places to go for help your congressman, contact the district office, second the state insurance commission. Finally while Social Security provides administration CMS (Center for Medicare and medicaid Services) makes the rules and should be able to help.  But I would start with the Fresinius insurance person.  Placing a statement on the memo line of your check may have avoided the hassle.  If Fresinius doesn’t help your best bet is the congressional office.  Years ago I worked with a gentlemen who grew up in Ireland where his father worked. He married his High School Irish Sweetheart.  Brought home his wife , then did something stupid went to Niagrarra Falls and crossed into Canada.  She was not allowed back into the US since she had a single entry visa.  The poor guy was driving every Friday to Canada to visit his wife.  He was told it would take months to resolve the issue.  I told him to call the congressman and within a week his wife was returned to the US.  All it cost him was the Congressman had a picture taken greeting him and his wife.

[PrimeTimer]

Fresenius Financial Coordinator said after being on dialysis 30 months they would help sign my husband up for Medicare. The 30 months came and went but she kept saying that she submitted the paperwork to Medicare. More time passes. No word from Fresenius, no Medicare card. Hubby contacts Medicare. They tell him to go talk to Social Security Administration, so he goes. Social Sec Admin tells him Fresenius Financial Coordinator submitted the wrong (and outdated) paperwork but Soc Sec Admin sat on that because it's not their job to call Fresenius or anybody. So...hubby submits the correct paperwork himself to Social Sec Administration and the waiting begins again. Fresenius starts calling us, wanting the status of Medicare payments because his employer insurance has nicely moved themselves into "secondary" position and instead of paying 80% as the primary, is now paying only 20% as the secondary. So, Fresenius tells hubby to call Medicare. Medicare says to call Social Secuirty Admin. And then at treatment one day, Fresenius Social Worker (not the Financial Coord) says "Hey, your insurance got all straightened out!". Wrong.

Fresenius starts calling us again and again, wants money. Hubby calls Medicare. They say to call Social Security. He goes in person to the Social Security Administration and a 20-something year old snit tells him "too bad too sad". Well, not exactly in those words but that basically altho they wrongly applied his $1500 check to future premiums, he cannot write them another check to make his Medicare coverage retroactive (so they turned down his money and sent him on his way).

Hubby works fulltime and is paying premiums on TWO insurance policies, Aetna and Medicare. This is in addition to having taxes, Social Security, Medicare, FICA, etc taken out of his paycheck. Fresenius said everything was taken care of but it wasn't. Medicare does nothing. Social Security Admin does nothing. Perhaps it is time to contact a Congress Critter. Oh wait, would that be the same Congress that does nothing? Okay, might give them a try but just sayin'....

We fight and we fight and we fight to do the right thing. We've always done the right thing. We want to do the right thing. And this is what we get. Sheesh....

Molon Labe!

[Simon Dog]

Hubby works fulltime and is paying premiums on TWO insurance policies, Aetna and Medicare.

It gets worse.    Around November of this year, he will get a letter stating that his Medicare premium is being increased because of the "earner's penalty".   I pay a hundred or two extra a month because I was getting severance pay in 2016.  (it lags by a couple of years).

Don't give up on the congressman thing.  Its a lot easier to have a congressional staff member help out a constituent and gain a lifetime of votes than accomplish anything on the hill.  The Chappaquidick Kid was famous for this.  He had a large staff that was very very good at helping people out

[cattlekid]

My employer knew *to the day* when they moved to secondary.  It's what prompted me to have a whole Keystone cops situation having to pay back premiums to Medicare to be able to back date my Medicare coverage to the exact date when my 30 month coordination period stopped.  I found out after the fact because my claims weren't getting paid by my employer insurance.  They knew to wait until Medicare paid, even though they didn't pay anything on any claims anyhow  because Medicare paid more than their contracted rates. 

And here's the one thing that was burned into my brain....when it comes to Medicare and the word "eligible"....it doesn't mean "you can get it if you want", it means "you have to take it because if you don't, you are on the hook for 100% of your own bills". 

Yet another snafu that made me count the days when I could tell Medicare to take a long walk off a short pier.

Here is a hypothetical question: Regardless as to whether or not Medicare has actually been paying as your Primary insurance provider, can your employer insurance (or private insurance) move themselves into "secondary" position and reduce the amount they pay on claims because you are simply "eligible" for Medicare? 

Put another way: I realize coverage on employer and/or private plans vary but are they allowed to stop coverage or reduce their coverage based on your eligibility to have Medicare as your primary? Or must they wait until Medicare has actually paid as your "primary"? Seems to me eligibility and actually receiving benefits are two different things. I would think that just because you are eligible for Medicare does not mean Medicare has actually paid anything.

[Paul]

I am going to have to stop reading threads like this because they make me so angry and that ain't good for my blood pressure (which is what killed my kidneys in the first place). In Britain the government picks up the tab for all medical treatment. The NHS isn't perfect, but when I read of the s*** you Americans have to go through I just thank Aneurin Bevan for creating it. For Heaven's sake America, there are third world countries with better health services than you. Get a clue!

[MooseMom]

I am going to have to stop reading threads like this because they make me so angry and that ain't good for my blood pressure (which is what killed my kidneys in the first place). In Britain the government picks up the tab for all medical treatment. The NHS isn't perfect, but when I read of the s*** you Americans have to go through I just thank Aneurin Bevan for creating it. For Heaven's sake America, there are third world countries with better health services than you. Get a clue!

We all know it's all a huge tragic mess, but too many people make too much money with the status quo, so there is no real will to change it.  But we also all suspect that we won't have Medicare nor Medicaid nor Social Security for too much longer, anyway.  It will be survival of the fittest.

Prime Timer, your situation is so aggravating.  I could tell you about mine, but my brain would melt.  I think we all have an "insurance nightmare story".

[Michael Murphy]

It appears you need a lawyer Fresinius employee stated this cluster truck and my guess is that they are liable.  Contact a disability attorney and also definitely contact CMS,

[PrimeTimer]

I recently bought my husband a bag of Starburst fruit candy chews. They help keep his mouth moist. He loves them. I tried a few myself. They are very tart. They are very addicting. Definitely makes your mouth water. But who knew the calming effect they'd have on me. Ahh !

So for the heck of it today I googled Fresenius, dialysis providers, Medicare and insurance and included the words "fraud, overbilling and confusion" in my searches. Wow...sure is a lot of it out there! People, we are NOT alone! I knew we weren't but it somehow made me feel better to see article after article of headlines complaining about dialysis providers, Medicare and insurance companies. There is an ocean of complaints out there and we (hubby and I) are just 2 small rowboats. So what to do? Keep rowing.

We recently moved to a new apartment and this time, one that consistently has running water and plumbing that actually works. It's a nice place. Love it. We also have a new cable company and are learning how to use all the new features it comes with. One such feature that I especially like is that when our phone rings (we have a land line) the name and number of the person calling pops up in the corner of our TV screen. Wow, it's caller ID! I know the technology has been around a long time but we are just now using it. I love it. Especially now because if I see that it is Fresenius calling I don't answer the phone. Let 'em leave a message. 

[PrimeTimer]

It appears you need a lawyer Fresinius employee stated this cluster truck and my guess is that they are liable.  Contact a disability attorney and also definitely contact CMS,

We've thought about getting a lawyer but feel that since we aren't the ones who created this mess then we shouldn't be the ones to take time and energy that we don't have to "fiight" this in any sort of way.

Here's what I think: The Fresenius coordinator screwed up the paperwork and the timing, Medicare screwed up the $1500 my husband sent them and Aetna jumped the gun and screwed up by not paying their 80% too early. Meanwhile, we've got caller ID. 

[kickingandscreaming]

Dayum!  It's not bad enough that we have this crappy disease.  We have to endure this insurance BS on top of it!

[Jean]

Prime Timer, I had that same feature and I just loved it!! Did not even have to move my butt two rooms away only to find out it was a sales person.