By Lance D. Reedy
For several years I have pounded the table with this central message: If you have any questions, thoughts, ideas, or concerns about anything connected with your Medicare plans, please call your agent first. Doing so can save you much grief and acid indigestion.
Before I get into the details about this topic, I want to describe an incident that happened with one of my daughters. For this discussion, I’ll give her the fictitious name of Susan. In March of 2016 Sue was hit as a pedestrian in a crosswalk while walking to class at the University of Idaho in Moscow. She ended up with a cracked vertebra and a broken scapula. She was initially transported by ambulance to Gritman Medical Center in Moscow and then to St. Joseph Regional Medical Center in Lewiston.
Fortunately, the woman driving the Ram pickup that hit Sue had liability insurance in force. I told my wife and daughter that it was imperative that we quickly secure the services of a top-notch personal injury (PI) attorney. Through a referral, we met with Ted Harris (also fictitious), Attorney at Law in Moscow.
I might add here, that if you ever need the services of a PI attorney, make sure that he is a TRIAL lawyer. Insurance companies know that they can’t play foolery games with an experienced trial attorney. I’ll also comment that even though our PI attorney charged the typical 33 1/3% of the settlement, he was worth every penny!
All the phone calls, hassling with the insurance company, and dealing with bill collectors was lifted from us. Not only was Mr. Harris worth his fees, he was able to put in a claim for under-insured motorists with our own insurance company as the offending party was under-insured. Sue ended up with a better settlement than she could possibly have imagined if we had done this on our own.
Additionally, Mr. Harris negotiated with the hospitals to re-price some of the billings. We were being billed the full-blown rate, and he used his influence to have those bills repriced to what the providers would have billed a health insurance company. That left a larger nest egg for Sue’s future physical therapy costs and who knows what else that might happen as a result of her accident.
About a year and nine months after the accident, attorney Harris had everything wrapped up and finalized, or so we thought. In December 2017 Sue received a letter from a local collection agency demanding payment of $850 for some past due medical bills. Her attorney said everything was wrapped up and finalized, and all bills had been paid out of the settlement. What happened?
I told my daughter that we’re not going to lose one second of sleep about this newest problem. I emailed Mr. Harris and attached a scanned copy of the collection letter. The $850 was for $675 of past due hospital bills and $175 in interest. I made NO phone calls to the hospital or collection agency. I just dropped the matter in Harris’ lap and said, “Please fix it.”
A week later he emailed me back that we could disregard the collection letter. When the hospital submitted their final bill to our attorney, they were legally, in fact, saying “Case closed, we have been paid in full.” Evidently, they had missed some bills for the final tally, or so they claimed, and since the bills were more than a year out, they turned it over to a local collection agency.
I will interject here that during my 18 years of being in the Medicare business, I have dealt with several billing mistakes. When there is some sort of a billing or claims issue, the chances are 90% or better that the billing office has made a mistake.
In Sue’s case, the hospital declared to our attorney that all bills were settled. It was legal finality; they agreed that that was it. Whether or not the billing office overlooked some charges is a moot point. They made a mistake by trying to charge Sue more after they had agreed that all charges had been settled.
In the end they agreed to “write off” the $650 and instructed the collection agency to drop that demand. Mr. Harris asked us if this was agreeable to us. “YES, of course!” I emailed back to him.
We called our attorney
We hired a pro attorney, and by doing so, that lifted the legal burden from us. After all, my wife was almost full-time for four weeks caring for our daughter. We turned it all over to attorney Ted, and he guided us through the entire process. The last thing we wanted to do was to hassle with an insurance company, and we didn’t! Oh yes, there were email consultations during the process, but we were relieved from the legal hassles. The entire saga went remarkably well.
Joe Called His Agent First
To protect the individuals’ privacy in the following events, I have changed their names and city of residence. Those are fictitious, but the events are real. Joe Jensen lives in Pinetree, Montana. In the summer of 2014 he was in a serious auto accident, and very well could have died from his perilous injuries. But in his 80s, Joe is one tough ol’ dude. He is like The Cat Came Back, he Just Wouldn’t Go Away. Remember the old camp song?
Joe was on a Medicare advantage (MA) plan when this near fatal accident happened, and he stayed on Medicare advantage through the end of 2017. When his plan provider terminated his plan effective December 31, 2017, Joe elected to return to original Medicare and go with a Medicare supplement plan instead of signing up for another MA plan.
Please keep in mind that during Joe’s recovery, Medicare was never billed as he was on a Medicare advantage plan. In mid-January 2018 Joe went to his medical supply store in Pinetree to pick up some home-health medical supplies. When Joe presented his Medicare card and Medicare supplement card, he received some unsettling news.
The proprietor told Joe that Always Safe (fictitious) was his primary insurer and that Medicare was his secondary insurer. Highly puzzled, Joe called me FIRST.
Here’s what happened. Joe’s auto-insurance company, Always Safe, became the primary insurer for some of Joe’s accident claims. Joe’s MA plan was the secondary in some cases. MEDICARE WAS NEVER BILLED because he was on an MA plan. For the remainder of 2014 all the way to the end of 2017, Joe was on Medicare advantage. After his recovery from his injuries, his Medicare advantage plan was his PRIMARY insurer, and the thing with Always Safe was in the past and long forgotten.
Even though there was a lingering old record of Always Safe paying some bills from Joe’s accident, it was a non-issue. It never came up. However, starting January 1, 2018, Joe was now on original Medicare, and his Part B providers would now be billing original Medicare and his Medicare supplement plan as his secondary.
Once the proprietor at Pinetree (Mac) checked his Medicare data base on his computer to verify Joe’s Medicare status, this thing with Always Safe popped up now that Joe was on original Medicare for the first time in four years. Also, Mac likely misinterpreted what he was reading on his screen, which added more confusion to the issue. He said to Joe, “Always Safe is your primary and Medicare is your secondary insurer.”
In a state of bewilderment, Joe did the right thing and called me. I told him that we needed to initiate a three-way phone conversation with Medicare. With the privacy rules and regulations, I cannot take care of this on my own. Joe must be on the phone to give his permission to the Medicare representative for me to speak on his behalf.
The Medicare rep, Chris, after hearing the story, directed us to contact the Benefits Coordination Recovery Center (BCRC) at 855-798-2627. We thanked Chris, called BCRC the next day, and quickly and successfully resolved the problem.
If Joe had been on his own, he likely would have started making phone calls with his Medicare supplement plan. That would have been useless. In this case, since he contacted me first, I was able to work with him on a step by step process to correct the problem.
She Called Me Last
I have run into similar situations where people have spent stress-filled hours on the phone trying to resolve a similar situation. In one case, Joan went to her pharmacist for a recommendation for a Part D prescription plan (PDP) for her husband, Scott.
In January 2018 Scott went to his pharmacist to fill his prescriptions, but the pharmacist told him that the charge to his PDP provider wasn’t going through. The result was that Scott had to pay full price. Joan went to work on behalf of her husband in an attempt to resolve the problem. She spent hours on the phone with both Scott’s pharmacist and his PDP plan provider in an attempt to fix the problem. Getting nowhere, she called me.
I explained to her that this was a Medicare issue and that sometime in the past Scott must have had prescription coverage through a former employer. I explained to her that she needed to call Medicare to fix this problem. Joan called me back a day later to explain that she was successful. Unfortunately, before calling me, she spent many frustrating hours on the phone getting nowhere.
Some people have voiced to me that they didn’t want to “bother” us with what seemed to be a trivial issue. The insurance companies compensate us agents for your business. As part of that picture, you are entitled to customer service from your agent.
Our daughter Sue needed help after she was hit by a truck. Sue hired a professional attorney to handle her legal needs and to reach a fair settlement. She didn’t have to deal with legal complexities or hassling with an insurance company!
Joe called me first when he ran into a problem, and as a result, he didn’t have to stumble around trying to fix it on his own. The burden was lifted from him.
Once Joan finally called us, we were able to quickly direct her to the solution for her husband’s problem. End