Can You Navigate the Medicare Maze?

"If you get a claim denial, always contact your doctor or hospital to see if they can help you through the appeal," said Shirley Whitenack, president of the National Academy of Elder Law Attorneys and a partner with law firm Schenck, Price, Smith & King.

Larry Tocco retired last year from a job in the collections department of a credit union. After some medical treatment, he started receiving past-due notices from health care providers after his claims on a Medicare plan weren't paid. After several frustrating phone calls, Larry learned he was still on the active employee roll of the health insurance plan covering his former employer. As a result, his Medicare plan was considered secondary coverage.

A benefits manager from the credit union told him they sent the retirement paperwork, but the representatives with the Medicare provider said they didn't get it.

The Chicago Tribune has the full story in an article titled “Steps to take when disputing a denied health insurance claim.”

Although Larry’s bills were less than $400, he worried about what could happen if he suddenly had a major health issue before the fiasco was resolved and couldn't advocate for himself. Given that Larry worked in collections, he understood keenly that if the past-due bills ended up going to a collection agency, his personal credit rating could be damaged. Larry kept careful notes of conversations with the insurance company, his former employer, and his current Medicare provider. That's hugely important for getting to a faster resolution on customer service and billing issues, the article explained.

When these companies won't talk to each other, you can get stuck. Just the same, patients are better off in the complaint process if they have documentation, the article advises. Keep a calendar diary anytime a benefits, health insurance, or contractor dispute comes up: write down the name, title, and phone number of the person you speak with and the contents of the conversation. Experts say that there are all kinds of glitches that can lead people to not being properly enrolled in Medicare.

The issue has been straightened out, and Tocco has finally been removed from coverage.

"I never thought this was how I'd be spending my time" in retirement, Tocco said.

For additional information about elder law topics and retirement planning in Houston, please click here to visit my website.

Reference: Chicago Tribune (May 29, 2015) “Steps to take when disputing a denied health insurance claim”