Healthcare/Insurance cost rant

FlowersGal, you are correct about how the supplemental plans pay. I have not had my supplemental plan deny any medical bills since I went on Medicare.

Clo, look at the dates Medicare paid & the dates your private insurance paid to see if there was any lag time between the two. I think your supplies falls under the Durable Medical Supplies under Medicare. Glad to read they were paid.

Straydog,

Medicare paid their portion and BCBS then denied their parts. The BCBS timeline is close to after the Medicare payment was made.

Medicare said they forward secondary insurance claims to the state of policy holders residence automatically - not the state the provider is located in. The policy holders insurance may mistakenly pay it, then they have to recoup those monies...then the supplier/provider can process the bill again to the correct BCBS state and hopefully the insurance will leave it or forward it to the correct state for processing. Then the bill will be paid. I think the issue is that this is an employer based insurance and not a true supplemental insurance....OR... based upon the state of residence on the policy holder the provider may not be recognized as an in network or preferred provider. It all depends upon the person that first processed the account. To correct the past claims everything must be done manually.

I've tried to find a way to circumvent the error from occurrence but have not been successful yet.

Clo

Clo, if you work for a large company that has medicare comparable insurance you don't have to sign up for medicare at all until you start collecting SS. Even then, if you continue to work you can use the employer insurance as primary and don't have to get Part B or a supplement. (Once you start collecting SS you must sign up for Part A). That was what my plan was before employer insurance started feuding with my provider network. I wanted to keep the employer insurance and no medicare so I could get the co-pay assistance for Inflectra.

I couldn't risk having all my docs and infusion out of network so that's why I am now on Medicare. I don't have employer insurance anymore even though I am still working. Medicare doesn't care. If I still had employer insurance that would be primary. Since I don't, Medicare is primary.

I will end up paying about $3000 more per year on Medicare from the premiums and deductibles and drugs costs than I would have with employer insurance with Inflectra co pay assist. For years my only health care expense was the premiums because the co-pay assist covered my max out of pocket, and that also meant that all my scripts were no cost to me because I had hit the max OOP. It was always the silver lining in being on Inflectra. I can't really complain. Now I have joined the rest of the world with health care costs.

I did keep my employer vision and dental since they are separate policies. And because I have them I am able to keep my Flex Spend account that I will use to pay for the medicare deductibles and drugs so as long as I am working, I won't really feel impacted by the extra costs.

I was unsure how that worked.

I took an early retirement and the previous insurance was available so I didn't have the "working Medicare vs. company insurance" questions....

That's how my Remicade payments worked with my insurance prior to Medicare. I stayed as long as possible because of the Remicade assistance program. My infusions ended up costing me 5.00....

But gosh... I really feel like I am walking a tight rope.

Thanks for explaining.
Clo