Author Topic: You CAN change your Medicare plan up until Feb 14  (Read 2217 times)

slccom

  • Guest
You CAN change your Medicare plan up until Feb 14
« on: January 24, 2014, 06:47:49 AM »
I just got a letter for my husband stating this. There is escape from Humana!

Sharon

Ripvanann

  • Hero Member
  • *****
  • Posts: 887
  • "A DESIRE FULFILLED IS A TREE OF LIFE"
Re: You CAN change your Medicare plan up until Feb 14
« Reply #1 on: January 24, 2014, 08:09:29 AM »
My mom has Medicare part F (supposed to cover everything) as a supplemental insurance. She's a widow on a fixed income and had an agent come over her to give her the best plans available. Yesterday she received a $232.00 bill fora Vit D. test that her doc had ordered back in June. She has High Vit D and High calcium. They determined from that second set of labs, that she has some sort of granular disease, most likely sarcoidosis.

Called insurance guy yet again today after many such bills have rolled in since this plan began. Insurance guy says that because Medicare deemed the test unecessary, neither Medicare nor her insurance would cover it. The way it is right now, any insurance co. can  legally deny you anything that Medicare denies. Whether or not they choose to do so or not, is up to them.

However, it also depends on where the services are performed. By law, hospitals that charge for anything more than Medicare says is necessary, insurance companies are not allowed to pay for it. The cost falls on the patient.

By the same token they also have to provide services that they don't think are necessary, or right, if Medicare says that they need to. When these services are not performed, insurance can deem the entire visit/appt. as inappropriate and refuse to pay.
Primary SjS, Steroid Induced Cushing's Syndrome, RA, Thyroiditis, Hyperparathyroidism, Raynaud's, Autonomic & Small Fiber NLeuropathy, Fibro. Osteoporosis, & other fun stuff associated w/ the afore mentioned. ~Meds: prednisone, Plaqu, Citracal D & Pain Meds, Compazine, phenergan, Iberogast.

litliwlowa

  • Hero Member
  • *****
  • Posts: 1780
Re: You CAN change your Medicare plan up until Feb 14
« Reply #2 on: January 24, 2014, 09:56:36 AM »
Andrea,

In that situation? I would also contact the doctor's office and request they revisit the diagnosis code they submitted the claim under, and resubmit with additional information supporting the medical necessity of the disputed test. Can't hurt to try that.

It's ridiculous that when a doctor deems a particular test medically necessary yet on the insurance end - who NEVER examines the patient let alone meets us face to face - total strangers go against the licensed physician's "hands on" best judgment.

Amanda

SJS-Primary; Hashi's, Post surgical hypothyroidism, Hypoparathyroidism, Spondylolithesis, L&C Facet Arthropathy, Fibro, gluten intolerance, TBI, Radiculopathies, Neuralgias, Osteopenia, GERD, Asthma, Allergies. Sphincter Dyssynergia. OSA, Fasciitis, Cervical Spondylosis, Cancer, etc etc etc

gurs

  • Hero Member
  • *****
  • Posts: 2709
Re: You CAN change your Medicare plan up until Feb 14
« Reply #3 on: January 25, 2014, 04:29:33 AM »
Oh, I just went through this..the Doctors office def needs to submit new codes...keep fighting it and hopefully they will straighten it out for you. Good luck

Gursie
52 years old.Primary SS, Lupus, Raynauds, POTS, Hormone issues from Hyster-menopause, systemic candida,osteoporosis,Gastroparesis, chronic neuropathy, migraines, sinus/dental issues. selective immune def/low t-cells.
Prednisone & medrol , plaquenil, diflucan, bio-estrogen creams,many supplements

Ripvanann

  • Hero Member
  • *****
  • Posts: 887
  • "A DESIRE FULFILLED IS A TREE OF LIFE"
Re: You CAN change your Medicare plan up until Feb 14
« Reply #4 on: January 25, 2014, 12:35:42 PM »
Told Mum about this and she's calling the doc on Mon. Thank you for the suggestion Amanda!

Gurs, great to know that it worked for you.

Primary SjS, Steroid Induced Cushing's Syndrome, RA, Thyroiditis, Hyperparathyroidism, Raynaud's, Autonomic & Small Fiber NLeuropathy, Fibro. Osteoporosis, & other fun stuff associated w/ the afore mentioned. ~Meds: prednisone, Plaqu, Citracal D & Pain Meds, Compazine, phenergan, Iberogast.

susanep

  • Hero Member
  • *****
  • Posts: 3693
  • Each Day Is A Miracle !
Re: You CAN change your Medicare plan up until Feb 14
« Reply #5 on: January 25, 2014, 04:22:42 PM »
I hope you get it straightened out. I have the basic Medicare, and part D for prescriptions, but would like to know what I need that would pay the hospital bill if I needed it, but don't want to end up with something I don't want. Don't know who to ask.

susanep :)
Sjogren's, Lupus, Rheumatoid Arthritis, Hypothyroid, Fibro, Sleep Apnea, Diabetes 2, Asthma, and Gerd.  (Meds I take) Omeprazole, Pilocarpine, Levothyroxine, Effexor, Cpap, Aspirin, Mobic, Prilosec,, Xanax, Restasis, Systane,Vitamin D3, Plaquenil, Gabapentin, Provigil , Advair, Nasonex, and Proventi

quietdynamics

  • Hero Member
  • *****
  • Posts: 2399
Re: You CAN change your Medicare plan up until Feb 14
« Reply #6 on: January 29, 2014, 01:03:51 PM »
Susanep

Here is the Medicare Plan Finder Site. http://www.medicare.gov/find-a-plan/questions/enter-your-information.aspx

My mother had Medicare and supplemental through AARP.

I kept waiting for medical bills to start coming in...but, everything was covered, Drs, tests, ambulance, Hospitalizations, nursing homes, ERs. and Hospice as well as all Meds.

In fact I received some reimbursement checks.

I am not sure what you would not want...as life is so unpredictable.
As a female one may not want to pay for prostate issues,,,but, then men pay for Gyn..in a package.
Economy of numbers, rather than the cost of tailored line item plans.
Sjogrens ANA 1:640; SS-A/B+; Fibro; IBS; Neuro symptoms,Thyroid Anti-bodies; Ocular Rosacea, Livedo reticularis,

"You can't have a positive life with a  negative mind"