Janie Slaven: TONI SAYS: Medicare is not paying my medical claims!

·3 min read

Aug. 10—Dear Toni,

My husband recently retired from his job and because I am over 65, I needed to sign up for Medicare. I went to the local Social Security office with the Request for Employment Information form (CMS L-564) signed by my husband's human resources 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 that 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. 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 do I need to do?

—Janie from Lake Charles, La.

Janie:

In the past few weeks, the Toni Says Medicare hotline has been receiving questions such as yours from others who are having their Medicare claims denied after leaving employer insurance. Medicare still has the employer group health plan listed as the primary insurance, which supersedes Medicare and the Medicare Supplement or Advantage plan applied for.

There is a process for leaving employer group health plans. Whether you are the employee or the covered spouse and enrolling in Medicare, you need to inform Medicare that Medicare should be the primary insurance and that coverage on an employer group health plan has ended.

To verify what your primary Medicare insurance is:

1. If you haven't already, visit https://www.mymedicare.gov/ and register for a MyMedicare.gov account.

2. Review what is in your MyMedicare.gov account and verify that your Medicare information is correct. From here, 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 Supplement plan you are enrolled in, Medicare claims and other Medicare issues.

3. If you see that the employer group health plan is still listed as primary after you and/or your spouse have enrolled in Medicare Part B, call the Medicare Benefits Coordination and Recovery Center at 1-855-798-2627 and advise the agent 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 also advising, when enrolling in Medicare when you are turning 65 (or later), opening a www.mymedicare.gov account, whether or not you have employer group health benefits. Once enrolled, Medicare mails the Medicare Summary Notice (MSN) every 90 days if any services or supplies were billed to Medicare during the prior 3-month period. You can also view your MSN by logging into your account, or you can choose to have it emailed. The last page of the MSN gives instructions for filing an appeal if you disagree with Medicare's decision to deny any claim.

Toni King is an author and columnist on Medicare and health insurance issues. She spent more than 27 years as a top sales leader in the fields. For answers to Medicare questions, email: info@tonisays.com or call 832-519-8664.