HEALTH CARE; When Medicare is not paying medical claims

Dear Toni,

My husband recently retired from his job and because I am over 65, I needed to sign up for Medicare. I had to go to the local Social Security office with the Request for Employment Information form (CMS L-564) signed by my husband's HR department to sign up for Medicare Part B. I asked if I needed to do anything else and I was told I was all set. A few weeks later, I received my new Medicare card in the mail with both Medicare Part A and B dates.

It was not until I went to the doctor and had my claim denied when I discovered that the old employer insurance was still listed as primary not Medicare.

Now my nightmare begins. The insurance company (Blue Cross/Blue Shield) said that I had to call Medicare to update Medicare's system. Medicare said it would take 10 business days to update. What do I do? I have no coverage because the company insurance is still listed as primary and neither Medicare nor my Medicare Supplement Plan G will pay. Please advise what I need to do. Janie from Sugar Land, TX

Janie:

In the past few weeks, the Toni Says® Medicare hot line has been receiving questions such as yours who are having their Medicare claims denied after leaving employer insurance. Medicare still has the employer group health plan, whether it is UHC, Cigna, Aetna, etc., as primary insurance which supersedes Medicare and the Medicare Supplement or Advantage plan applied for.

There is a process that those leaving employer group health plans. Whether you are the employee or the covered spouse and enrolling in Medicare should do to verify which is considered primary insurance. Also, you need to inform Medicare that Medicare should be primary, and that you or your spouse are no longer covered on an employer group health plan.

The verification process to discover what is your primary Medicare insurance is below:

1) Visit www.mymedicare.gov and register for a MyMedicare.gov account.

2) View what is in your MyMedicare.gov account and verify that your Medicare information is correct. Knowing this information, you will be able to view what Medicare is viewing while you are discussing your Medicare issues such as what Medicare plan you are using, what Medicare Part D plan you are enrolled in, Medicare claims and other Medicare issues.

3) If you see that your employer group health plan is still primary after you have enrolled in your and/or your spouse's Medicare Part B, then Medicare is requesting that you call the Medicare Benefits Coordination & Recovery Center at 1-855-798-2627 and advise the agent who answers that you and/or your spouse are no longer enrolled in the employer group health plan. The change from group health insurance as primary insurance to Medicare is estimated to take 48 hours. We are advising those on Medicare to open a www.mymedicare.gov account when enrolling in Medicare whether you are turning 65 with or without employer group health benefits. Medicare mails out the Medicare Summary Notice (MSN) every 90 days or one can view it faster via www.mymedicare.gov or www.medicare.gov.

Please email the Toni Says® Medicare team at [email protected] or call 832-519-8664 regarding Medicare questions including Toni's stress-free way to enroll in Medicare. Sign up for Toni Says® newsletter at www.tonisays.com to keep up to date on Medicare changes

Toni King, author of the 2022 Medicare Survival Guide® Advanced edition is giving a $5 discount on the Medicare Survival Guide® Advanced book at www.tonisays.com.