(Toni Says) Help … my employer's health plan denied $22,000 claim

Dear Toni: I am retired and have moved to My oncologist's office manager advised me that because I am over 65, I may want to apply for Medicare and leave my employer health insurance. Linda, the office manager, said that my health plan denied my claim for my cancer treatment because the plan considers it to be experimental and will not approve paying for this care.

The specific cancer treatment costs me over $22,000 per month which I am paying from my 401k, draining what I need to retire. I am not retiring from my job but using the 12 weeks of vacation time I have, so that I do not lose my current full-time salary.

Linda said that Medicare will pay and provide the care I need because she currently has patients on Original Medicare with a Medicare Supplement. She files their claims without a problem. I need to know how to begin my Medicare benefits as quickly as possible. Please advise me what I need to do. Thanks, Toni. — Bart from Memphis, Tenn.

Hello Bart: A health care professional advised me that many of the new cancer procedures are not approved by individual and employer group health insurance plans. The doctor said that these procedures are generally approved with "Original Medicare" and his office has referred his patients to my website at www.tonisays.com to contact the Toni Says Medicare team because enrolling in Medicare past 65 while still employed is complex. (Chapter 1 of my Medicare Survival Guide Advanced edition helps Americans understand enrolling in Medicare, step by step, under most scenarios.)

Enrolling in Original Medicare past 65, while employed and leaving employer benefits, is the same whether:

1. Health issues are not covered by an employer health plan: You (or your spouse) are still working with health issues (like Bart) and the employer health insurance plan is not covering the doctor's procedure. Even though you are not retiring, you need to enroll in Medicare.

2. Laid off: You (or your spouse) are laid off and need to enroll in Medicare.

3. Retiring past 65: You (or your spouse) decide to retire past 65 and need to enroll in Medicare.

The process to enroll in Medicare past 65 must be followed correctly, and is as follows:

1. Social Security forms: Request for Employment Information (CMS-L564) must be signed by the employer's human resource representative for you and/or your spouse who are covered on company benefits. Application for Enrollment in Medicare Part B (CMS-40B) must be filled out and signed by you (and your spouse if they are also enrolling in Medicare). These two forms are available at the Social Security website (SSA.gov).

2. At the top of the Request for Employment Information (CMS-L564) form, it is very important to write "Special Enrollment Period" to inform the Social Security agent processing the form that you are signing up at the right time, and prevents a Medicare Part B penalty. If you have had two or more jobs since turning 65, each of those companies must sign a form.

3. Make copies of your completed Application for Enrollment in Medicare Part B (CMS-40B), stating what month your Medicare Part B should begin, with the CMS-L564 form(s).

4. Take your original forms to your local Social Security office for Medicare to begin. Keep the copies of the paperwork in case the paperwork is lost.

Remember, with Medicare what you don't know WILL hurt you! When leaving your or your spouse's benefits or employment, you have only 8 months to start Medicare and avoid receiving a Part B penalty. Wait longer than 8 months and you will have a Medicare Part B penalty.

Toni King is an author and columnist on Medicare and health insurance issues.

The post (Toni Says) Help … my employer's health plan denied $22,000 claim appeared first on St. Clair News-Aegis.