Insured or Not Insured

[cmahmood]

What is the name of your state (only U.S. law)?What is the name of your state (only U.S. law)? New York
I'm a 65 yoa female who had to take retirement with a disability retirement pension eff May 31, 2001 from an international bank. At time of retirement, was given retiree "under age 65" health insurance benefits. In December 2002 received Medicare offering for Part A and Part B coverage effective 3/1/03. Read the book on 2003, phoned NYS Medicare and bank's Corporate Benefits, all to determine if I needed to take Medicare Part B at that time. (Kept notes on calls, phone numbers, people spoken to and date and time.) Determined by all that I did not need to take it at that time. Banks Corp. Benefits Dept. was located in NYS in 2002. Due to bank acquisitions, Corp Benefits has been moved to another state since then with a second move since. Had periodic problems getting claims paid and wrote letters to health carrier (have copies of all). Claims were ultimately paid. Have been paying $8400 annual premium (my share for husband and self) which is deducted from my pension payment monthly. In July of this year was hospitalized for 3rd pacemaker. Am on coumadin (blood thinner) for prosthetic heart valve and have to be hospitalized. Hospital submitted bill for over $32,000 which they kept denying saying Medicare was responsible. I kept phoning insurance carrier and they finally paid. Incidental bills from Cardiac physician and labs were in limbo after they kept notifying them (dr. and lab) that I should have medicare but did not. Kept phoning insurance carrier and being referred to "rapid resolution". Was finally told by two people there that I should have been on Medicare Part B since 2003. They said they would be going through all of the claims since 3/1/03 and making reversals of payments In the meantime, since early summer I had been receiving information from banks Corp. Benefits on the change that would be up and coming on August 1 2009. I should then take Medicare Part B, I would be put on bank's "over 65" health care benefits (they would become secondary payor on Part A only and I would have prescription coverage through the bank (total coverage $20,000.) Also received "proof of coverage" letters from the bank in June this year. Called Corp Benefits on 9/15/09 (same day insurance co said they would be reversing all payments made to providers). Spoke to 2 different people there and was given a case number and told that a specialist would be getting back to me by following Monday (21st). Did not hear anything from them and finally called them back on 10/6/09. Spoke to a 3rd person who got me in touch with the specialist. Specialist said she was sorry for the delay but the Benefits dept. had just moved again. Said she would make phone calls to ins. carrier and call me the next couple of days. She did call me the very next morning. She said she had spoken with the carrier and that it had been agreed that no reversals would be made. She also went over the "over 65" terms with me and stated that I needed to go on Medicare Part B. I told her that I was on Part B effective 8/1/09. My question is....the doctor who performed pacemaker surgery on 7/7/09 was paid on the wrong premise. She was paid $586 on bill of $2983 on 10/1/09, EOB stating that Medicare was responsible but I did not have it. (Under the terms of my employer, they should have paid nothing on Part B). I believe my employer dropped the ball in that they did notify me that I was obligated to take Part B on 3/1/03 and I had called them on 12/13/02 and asked them that very question. I did not have Medicare Part B on 7/7/09. According to Ins Co. EOB, Medicare should have paid $2344. Isn't my employer by 1) taking premiums out of my pension since 6/1/01, 2) incorrectly advising me on 12/13/02 that "under 65" was my primary carrier, 3) accepting responsibility by making agreement with insurance carrier to "no reversals" of prior claims, 4) never advising me in writing that I would need to take Part B when offered. I was asked if I had ever received anything in writing and advised them that I had not (and also about the phone call on 12/13/02). I still live at the same address that I have lived since 1999. Anything you can suggest?What is the name of your state (only U.S. law)?

[ecmst12]

It was very difficult to read your huge block of text. You should edit it to include some paragraph breaks.

It sounds like your medicare eligibility prior to age 65 confused some people at your insurance company. It is very common for insurance plans to state that if someone is eligible for Medicare, they MUST take it or else claims will be paid as if medicare paid, whether it actually did or not. Your insurance was paying wrong all this time when it was treating you as if you were NOT medicare eligible when you were. They are now correcting the error as is their legal right. You will now be responsible for all the payments that medicare WOULD have made, had you elected it.

I do think it's ridiculous that they want to go back 6 years for this, but I'm not exactly sure what action you can take to protect yourself. Obviously you need to enroll in Medicare at the next available opportunity. Other then that, I would advise contacting your state department of insurance for assistence. They may not be able to help much since your plan is likely governed by federal and not state law, but they may be able to point you in the right direction. You might also want to have a consult with a consumer protection attorney. The insurance company is going to be taking the money back from your doctors, so it is the doctors who will be coming after you for payment, they are going to be the innocent bystanders who just want to be paid for the services they provided. And it doesn't sound like you have anything in writing confirming you did NOT need to enroll in Medicare, either. So...it's going to be a tough fight. Good luck.

[lkc15507]

Agree extremely hard to read. Harder to comprehend. But, a comment or two. When you elect Medicare Part B is entirely up to you. No one else's responsibility but yours. Because of that, perhaps I am missing something, but I cannot identify the source of your angst. No one but you is responsible for your proper coverage be it Medicare or an employer plan. The employer plan is not obligated to counsel you on Medicare coverage and Medicare does not counsel you on eligibility for employer coverage. Sorry, but what have I missed that you think otherwise?