Timing with Medicare and Private Insurance (Primary/Secondary question)

[Deanne]

I wasn't notified that Medicare has become my primary insurance (just a grrr!), but it seems it happened. BCBS refused a claim stating that my doctor's office was supposed to bill someone else first. I called Medicare, who said they are my primary. I called BCBS to confirm that this matches their records. They said they'll update their records to indicate this. Apparently the person I talked to doesn't know, either. The timing is about right, so I called the doctor's office back to tell them to swap my primary/secondary.

Question #1: Is there supposed to be any type of notification from Medicare when they become primary?




I started Medicare six months before my transplant and I know I need to keep it for 36 months.

Question #2: Does the 36-month clock begin the day I started Medicare (cancel date this September), or the day I got my transplant (cancel date next February)?



Thanks!
Deanne

[Michael Murphy]

I just went trough this, the law states that after 3 months on dialysis a 30 month clock starts after that 30 months or 33 months after the start of dialysis you must be on Medicare and Medicare must be primary.  The social worker at the center is the only one who talked to me about this.  In fact when I went to social security to apply for Medicare I was told I wasn't eligible it took 3 hours of arguing to convince them I had to switch to Medicare.  If you are paying for your private insurance that is now secondary you need to check out Medigap and advantage programs since you now have the opportunity to join them with out medical exclusions. Since you now are being charged Medicare rates these programs provide better coverage at cheaper prices for most people. I was fortunate that my wife's company wanted all retired employees to switch to Medicare, and the did this the nice way, they offered a enhanced coverage plan that paid every thing along with a better prescription plan and dental coverage.  All this for a reasonable price a win win for me and for the company, lower prices for me and lower costs for them.

[Charlie B53]

I have to admit that I am still not understanding just how this Mandatory switch to Medicare applies to me.   I started SSD shortly after the Dr's convinced me that I 'had to' get off my feet and stop work, threatening me that I would lose both legs if I persisted in working.  So I went part-=time for almost a year.  The swelling initially was better, but it wasn't long even with those terrible uncomfortable thigh-high heavy support hose my legs would still balloon and leak.   This was almost 4 years before my kidneys got so bad that I started PD.  That was 3 years ago.   I am well past that 30 or 33 month limitation and so far I haven't heard a word about Medicare becoming primary.

I've been going to the VA Hospital for care pretty much ever since I got out of the Army in '75.   The VA did make a copy of my Medicare card many years ago.  Other than that I have never heard a word.   And no letters from Medicare.

All I know for sure is I have NEVER gotten any bill from anywhere.   That's' not true.  I once got a bill from some Dr's Association for the ER Dr.   I was suddenly freezing and shaky, went to bed with my dogs to warm up, couldn't.  Wife took my temp, called our son.  He physically made me get up, wrapped me up and took me to the ER.  I spent 12 days. A leaky leg somehow got infected.   Evidently the ER Dr's billing Association didn't bill the VA like the Hospital did.  So their bill was denied.   I was told by the VA NOT to pay it, the billing Co screwed up, not my fault.    I did have the Medicare card at that time, the Hospital also has a copy.

Am I 'special'/   Or very fortunate?

[Michael Murphy]

The 33 month limit applies to people using private insurance.  The VA is a separate system.  Most people are better off on private insurance because of the drug plans.  Sensipar and Renvella drive the reason people would prefer private drug solutions.  I don't think VA patients are faced with the Medicare choice.

[Deanne]

I'm not on dialysis. I had a transplant after 6 months of dialysis. My question is whether I can cancel Medicare in August this year (36 months after starting Medicare), or if I need to wait until next February to cancel it (36 months post-transplant).

I've always had insurance through work and until now, my private/work insurance has been primary. Medicare just became primary.

[cattlekid]

I can give information based on my experience.

#1:  I did not receive any notification from Medicare when they became primary.  Like you, I got claim rejection notices from BCBS and then I had to call a handful of providers and have them resubmit claims to Medicare first and then back to BCBS.  It was a lot of back and forth and a few nastygrams saying that I had overdue bills until everything was straightened out. 

#2:  The 36 month clock begins the day of your transplant.  I just received a letter from Social Security Administration that my Medicare coverage ends on April 30 - I received my transplant April 16, 2013.   According to the letter "Medicare coverage based on a kidney condition ends the last day of the 36th month after a kidney transplant".  Medicare coverage will extend if you get another transplant or go back on dialysis in the 36 month period. 

The part that aggravates me is that the SSA also sent me a premium due notice back in February asking for a full three month premium payment, which I dutifully paid as I didn't have the energy at the time to wrangle with them.  So now I should be getting a refund for the month of May.  Let's see how many calls it will take to arrange it.   

I wasn't notified that Medicare has become my primary insurance (just a grrr!), but it seems it happened. BCBS refused a claim stating that my doctor's office was supposed to bill someone else first. I called Medicare, who said they are my primary. I called BCBS to confirm that this matches their records. They said they'll update their records to indicate this. Apparently the person I talked to doesn't know, either. The timing is about right, so I called the doctor's office back to tell them to swap my primary/secondary.

Question #1: Is there supposed to be any type of notification from Medicare when they become primary?




I started Medicare six months before my transplant and I know I need to keep it for 36 months.

Question #2: Does the 36-month clock begin the day I started Medicare (cancel date this September), or the day I got my transplant (cancel date next February)?



Thanks!
Deanne

[Deanne]

Thanks!

Shoot on having to wait until next year to cancel Medicare. I was starting to get my hopes up about canceling this year. It's expensive!

The lack of notification about the switch to Medicare being primary is annoying. It sounds like it hit you much harder than me. My medical care is almost all through the same entity, so I only had one glitch and thankfully, the biller called me to tell me the claim was rejected before they billed me, so I was able to quickly check it out and then tell her to bill Medicare. Whew! I told her how grateful I was for her call. Then when I called BCBS to confirm they were secondary, it seemed like they didn't know what I was talking about, despite the fact that they're the ones who rejected the claim. I hope it's all resolved, but they screw things up so often, that I won't be 100% confident until the next billing cycle.

Thanks also for warning me about what to expect next year when it's time to cancel it. I'd think it would make their lives easier, as well as ours, if they'd get their acts together. How many people are they paying to handle our calls due to their inadequacies?

[cattlekid]

I just called SSA and I was quoted a 35 minute wait so I am waiting for a callback instead of hanging on the phone.  I'll let you know what they say about the refund.  I'm not holding my breath.   

[Michael Murphy]

 It's not just Medicare I had Aetna insurance at my job my wife had Aenta which became my secondary, at least once a quarter I had to call Fresinius because they billed Atna and called me with a 1500 dollar bill for me to pay. I would call and ask, they would tell me that Aetna did pay and I would have to, I would ask if they billed my secondary policy and would hear I only have Aetna I would then point out Aetna was both Primary and Secondary and Bill the Secondary Aetna.

[cattlekid]

I forgot to update! 

I got my callback exactly at the time quoted.  When I spoke to the SSA representative, she said the refund was already in progress and I should be receiving a check by the end of the month.  You could have knocked me over with a feather.   

I just called SSA and I was quoted a 35 minute wait so I am waiting for a callback instead of hanging on the phone.  I'll let you know what they say about the refund.  I'm not holding my breath.