Insurance is asking for reimbursement because I have Medicare part A and not part B

[Mimi K]

Attorney I spoke with said it would be so costly that only if you were dealing with hundreds of thousands of dollars would it be worth it. Bottom line folks....it is up to us to gather the knowledge (write it down) and use it. It is very difficult to say to the company I worked for "why wasn't I told" or to the broker " what information did you give insurance company when switched last April". I wasn't in the office so my medical info was filled out for me. Company has always paid 100 percent for me and prior to that in the 23 years I worked for them...they covered my children and husband too...100 percent. I can't bash them because we were family and they were wonderful to me.
Now I will be negotiating with doctors and others to set up payment plan. I haven't heard from social security appeal but I will be eligible in July for Part B.
I have had to cancel appts that required ultra sounds and MRIs. I would love to name the insurance company but doubt monitors would approve.
I'm depressed and that is causing fatigue to be worse or the fatigue is causing depression to be worse.
I will survive this and I do hope my experience will help someone. That would make me happy.

I was so stubborn in the beginning I could handle everything but those with cognitive issues.....get help so that someone else is listening too and you can compare notes and they can ask the questions you can't think to ask.

[MSW1963]

Mimi K, I wish I could say that I'm shocked to hear the bad news, but big insurers are in the pockets of those in authority who should be protecting us from this kind of 'abuse'/mistake.

You would think if this type of thing happens with any kind of regularity as the insurance commissioner indicated, something would be done to correct the problem.

I hope your docs and care providers work out a manageable repayment arrangement.

[MSW1963]

How in good coconscious can the insurance commissioner in your state say this problem happens 'all the time' and allow it to continue when it has the potential to cause such hardship, possible financial ruin for the insured individuals?

What can possibly be the excuse after acknowledging this ongoing systematic problem, then make no attempt to correct the problem or provide no relief or solution for taxpayers, who by the way, pay the commissioner's salary? The insurance company 'bonuses' must be very lucrative.

Sorry, but I'm furious about the commissioner acknowledging an ongoing problem when no attempt to correct it has been made, and send you on your way. Shame, shame on these useless well paid boutocrats.

[pennstater]

Mimi,

So sorry to read this. Thanks for the heads up.

Do you have anything in writing from the commissioner's office? Does it reference common practice? You may want to involve your state rep and senator. I agree that corrective laws needed. Maybe your rep can help you get a different resolution. Just because it is common doesn't make it right

Good luck to you.

[Mimi K]

I feel I am being treated as though I did something illegal. Stupid is illegal is it

Why didn't I ask for a letter from commissioners office instead of a phone call or at least in addition to the phone call.

The company I worked for for said..you are considered an employee until 65...they still pay for my dental care with another company.
The insurance company is Coventry of Georgia and even though I am living in Florida the policy covers out of state networking. My letter was to Georgia commissioners office.

I don't need daily care but I so wish that I had had someone with insurance knowledge at my side. I am a very honest person...growing up with ...your character is everything....and on the down side ...mind over matter (which kept me in denial for a very very long time).
I don't even have the name of the person I sat with at the social security office! I didn't get a copy of my letter (written there to appeal).

[MSW1963]

Insurance companies doing business out of their domicile state, are required to apply with and be approved by the state of Florida to issue insurance policies there. The state of Florida in late 1990, early 2000 has a particularly poor history when it came to regulating insurance. My home state had more than one commissioner serve prison time for illegal kickbacks from insurance companies.

If you have the 'case' number for the insurance commissioner's investigation, you should request written copies of those records and names of the individuals involved.

Don't be too harsh on yourself about not getting names or written documentation. Stressed sick people unfamiliar with the bureaucratic system it's understandable, sometimes exploited by the unscrupulous. Easy up on yourself, get the documentation, and as pennstater suggested, get your legislators, even local media involved. Best of luck

[jreagan70]

Hi Mimi:
I’m so sorry to read about what happened to you. What a nightmare!

I’ve been reading your thread with interest. I can see why you’re confused because there’s some information missing from you story and the pieces don’t quite fit together. It wasn’t until you posted about the broker getting involved a year ago that I even had a clue about how it might have happened.

Since you have to try to reconstruct what happened, I have some ideas about the information gaps that might be helpful. I’ll post them later.

But for now there’s something really obvious that’s wrong with what you posted that nobody has brought up yet.


You said in your first post that you sent on Social Security disability (SSDI) in 2011 and that “my insurance company is saying I should have gotten part B at the time and didn't and I now owe them everything they have paid for me to doctors and hospitals since 2011.”


First of all, that isn’t even possible. People on SSDI don’t become eligible for Medicare until two years after they go on SSDI. So you weren’t eligible for Medicare until 2013 and couldn’t have gone on Part B until then. So it isn’t possible for you to have to pay back to 2011 when the applicable time period only goes back to 2013.

Now I’m assuming that it was your former employer who hired the broker a year ago April to find them a new carrier for their group medical insurance and you were included in that. You also said that new paperwork was filled out for you at the time, so I’m assuming that means that your current insurance company – the one that’s asking to be paid back -- has been your carrier for only the last one year, since April 2014. So that would mean that you would owe that company only for the last one year that they were paying your medical bills. Again, impossible for you to owe them going all the way back to 2011. They weren’t even your carrier before last year, 2014.



Finally, the argument can be made that the new insurance company would have been responsible for paying something toward your medical bills as the secondary carrier to Medicare. So you might argue that you should not have to pay back the amount that they would have been responsible for paying anyway (even though it might be very small) as the secondary carrier.



Just some basic facts about SSDI and Medicare make it impossible for you to have to pay anybody going back all the way to 2011. 2014 maybe, 2013 possibly, depending on a whole other can of worms.



Part of the worminess in that can was pointed out by poster MSW 1963 about how your employer kept you on a group plan when you were no longer an employee. How that was handled at the time you “retired” under SSDI might have been done innocently, but may have set a series of things into motion that led you to make the decisions you made. That’s kind of complicated, so I’ll have some more ideas for you later.

In the meantime, I hope you feel a little better that you won’t have to pay back as much money as you were afraid of.

[MSW1963]

Mimi k, jreagan70 brings up a good point about the 2yr waiting period for Medicare A and B eligibility.

I came across a Medicare Rights.org site linked here:

http://www.medicarerights.org/part-b...ment-nov-2014/

The site does mention circumstances that SSA has offered retroactive Medicare B eligibility. It also provides examples of contradictory Medicare eligibility notices sent to individuals by insurers and SSA.

Also makes me realize what do I know?!

Take care and hope the link is helpful.

[COLOR=NAVY]**Edited in compliance with MSWorld Guideline #4**[ /COLOR]

[jreagan70]

Hi Mimi:


I know you’re trying to figure out why nobody told you that you had to take Medicare Part B because your current medical insurance would only be the secondary carrier. In looking at the timeline of events, it may very well be that a situation never arose in which that kind of conversation would logically have taken place.

Back in 2011 when you went out on SSDI, you weren’t eligible for Medicare, so there wouldn’t have been any reason for anyone to talk about it. Social Security had no reason to talk about it, except maybe to tell you that it would be two years before you would be eligible for Medicare, so be sure you have medical insurance in the meantime.

And there wasn’t any reason for your company’s HR person to talk about it because it wasn’t an issue then, and wouldn’t be for two more years. In fact, your company’s HR person may not even have enough knowledge to know anything about Medicare anyway, since the company stops paying for employee’s medical coverage at 65.

So if your company’s HR person doesn’t know anything about Medicare, they probably didn’t have any clue that you would be come eligible at some point and not know what that means anyway. Then it makes sense that they wouldn’t have known to say anything to the broker about it in 2014. And if nobody knew it was an issue then, there wasn’t any reason for anyone to say anything to you about it.

The only time it makes sense that the issue might have come up was in 2013, when Social Security put you on Medicare. And if you didn’t start the conversation with your company’s HR person then, it makes sense that the topic just never came up. And even if it did, it’s possible that your HR person just didn’t have the knowledge or experience about Medicare to be able to give you any information about it.

The only thing that’s left is the actual time in 2013 when Medicare sent you your enrollment package.

People on SSDI are automatically enrolled in Medicare Part A and Part B two years after SSDI goes into effect. So you were already automatically enrolled in Part B back in 2013.

For a person on SSDI to decline Part B, they must actively, intentionally take steps to disenroll. The Medicare enrollment package includes instructions for how to disenroll from Part B. That procedure involves intentionally sending the Medicare card back to them so they can issue a new one for Part A only. So even though you don’t remember doing that, you had to have intentionally disenrolled because that’s the only way you could have lost your Part B coverage.

So in your appeal to Medicare you might be able to argue that their enrollment package didn’t give you enough information about small company group medical plans for you to know how to make the right decision about keeping or declining Part B. And maybe they will re-establish your Part B retroactively.

I hope you can get this all straightened out with a minimum of grief.

[Mimi K]

I have the most wonderful news!!!!!

Please, please help!!! When I received social security disability in 2011 I was happy the process was over. Although, I was receiving long term disability and paid insurance through the company I had worked for 23 years.
I have part A. Now the nightmare...my insurance company is saying I should have gotten part B at the time and didn't and I now owe them everything they have paid for me to doctors and hospitals since 2011.
I am devastated and confused.
I don't know how the system works but I must learn very quickly.
mimi

I just received a letter from social security and they have agreed to enroll me as of May 2014!!!! This has been a tough one. The good news is that they listened to my truth and was heard!!!!! My faith in the universe is restored!

[MSW1963]

MimiK, I'm so happy for you! Congratulations on the good news, and so fast too! I'm feeling a bit of restored faith in humanity myself.

[MSW1963]

Suggestion for Administrators

MimiK and administrators, this is a useful 'Sticky' topics post, and a great topic for General Questions. Members could learn a lot about SS/Medicare benefits, that it's worth perusing SS/Medicare for consideration if your situation has merit.

[Mimi K]

Clearing up a few things.

Hi Mimi:
I’m so sorry to read about what happened to you. What a nightmare!

I’ve been reading your thread with interest. I can see why you’re confused because there’s some information missing from you story and the pieces don’t quite fit together. It wasn’t until you posted about the broker getting involved a year ago that I even had a clue about how it might have happened.

Since you have to try to reconstruct what happened, I have some ideas about the information gaps that might be helpful. I’ll post them later.

But for now there’s something really obvious that’s wrong with what you posted that nobody has brought up yet.


You said in your first post that you sent on Social Security disability (SSDI) in 2011 and that “my insurance company is saying I should have gotten part B at the time and didn't and I now owe them everything they have paid for me to doctors and hospitals since 2011.”


First of all, that isn’t even possible. People on SSDI don’t become eligible for Medicare until two years after they go on SSDI. So you weren’t eligible for Medicare until 2013 and couldn’t have gone on Part B until then. So it isn’t possible for you to have to pay back to 2011 when the applicable time period only goes back to 2013.

Now I’m assuming that it was your former employer who hired the broker a year ago April to find them a new carrier for their group medical insurance and you were included in that. You also said that new paperwork was filled out for you at the time, so I’m assuming that means that your current insurance company – the one that’s asking to be paid back -- has been your carrier for only the last one year, since April 2014. So that would mean that you would owe that company only for the last one year that they were paying your medical bills. Again, impossible for you to owe them going all the way back to 2011. They weren’t even your carrier before last year, 2014.



Finally, the argument can be made that the new insurance company would have been responsible for paying something toward your medical bills as the secondary carrier to Medicare. So you might argue that you should not have to pay back the amount that they would have been responsible for paying anyway (even though it might be very small) as the secondary carrier.



Just some basic facts about SSDI and Medicare make it impossible for you to have to pay anybody going back all the way to 2011. 2014 maybe, 2013 possibly, depending on a whole other can of worms.



Part of the worminess in that can was pointed out by poster MSW 1963 about how your employer kept you on a group plan when you were no longer an employee. How that was handled at the time you “retired” under SSDI might have been done innocently, but may have set a series of things into motion that led you to make the decisions you made. That’s kind of complicated, so I’ll have some more ideas for you later.

In the meantime, I hope you feel a little better that you won’t have to pay back as much money as you were afraid of.

Company changed insurance companies in May 2014. I won't even mention the other insurance companies name. In November of 2014 I had a blood clot in my leg and was hospitalized. Hence, part A came into play. It is during this time may 2014 to present that they are requesting funds paid.
Social Security does not have anything from me in writing nor a returned card. As I told them...it was a short phone call...where I said I have group coverage (not knowing).

I do feel it is a message for those of us with cognitive issues (even though we deny they exists at times) to have a representative help us through stressful times. Another ear to confirm what we have heard or asked.

Social Security acknowledged they had nothing on file (returned card or signature declining). Personally, all I remember is the short phone conversation stating I had group coverage through my employer.

Right now I am feeling relieved and a huge burden lifting. I will feel even better when I receive my card stating part A and part B.

When we are going through stressful times...it is hard to concentrate to stay focused. Whether newly diagnosed or sad from the hand we've been dealt. Don't pretend you can handle everything and everything is normal....it is a new normal

[jreagan70]

Social Security acknowledged they had nothing on file (returned card or signature declining).

If Social Security/Medicare doesn't have anything on file to indicate that you disenrolled from Part B, then it sounds like it's their goof and not yours. And what a colossal goof!

Thank goodness they stepped up to make things right for you.

Thanks for the update, Mimi. I'm so glad it all worked out for you!

[Mimi K]

Emotional toll this has taken can not be measured

If Social Security/Medicare doesn't have anything on file to indicate that you disenrolled from Part B, then it sounds like it's their goof and not yours. And what a colossal goof!

Thank goodness they stepped up to make things right for you.

Thanks for the update, Mimi. I'm so glad it all worked out for you!

Have not received my social security card stating May 2014 but did get a card for April 2015. I had to pay over 1,000.00 for back fees from 2014. Waiting anxiously for the check to clear. I still have the letter though so I feel safe.
The emotional toll has been a heavy load. Asking for details of 2011 is funny for us that have memory problems. Thank you to all for support.