Confusion about Medicare
As an old man, I get Medicare coverage. So does my wife. We are both also covered by our employers' health plans. Because I'm retired, and my wife is still working, her plan is primary, Medicare is secondary, and my employer's plan is tertiary -- for both of us. The tertiary plan seldom pays anything, but that's not the point.
Most years, around the first of the year, her plan starts sending out the same questionnaire with every EOB (explanation of benefits), asking whether that status has changed. She fills out one and sends it back, but they keep on coming for a couple of months. During that time, they reject every claim with the explanation that certain information has not yet been provided by the plan member. Some of the providers get worried, and we try to calm them down until the dust settles.
This year there were no questionnaires. Instead, her plan is rejecting every claim with the explanation that they have to know why Medicare rejected the claim. That's funny, Medicare couldn't have rejected the claim because they don't get it until after her plan processes it. Oh, I see. Suddenly, on January 1, they forget they're primary and think Medicare is primary.
So as soon as each EOB comes, we get on the phone, push the right buttons to escape from the automated system, wait for a human "representative," and explain that they're really primary. The representative says they will reprocess the claim. The providers still get worried. The other day I fielded a call from one and explained that we take care of the problem and they will get their money.
This is just one example of the hassles we get into because of the multiplicity of health coverage plans. And these are good plans -- I'm grateful that we can afford to pay for the "traditional plan" and don't have to fall back on the mercies of an HMO. Still, many providers are confused. Every once in a while I have to phone a provider to explain which plan is primary, or who gets the claim next.
For a supposedly advanced country, we sure have a stupid health care system.
Most years, around the first of the year, her plan starts sending out the same questionnaire with every EOB (explanation of benefits), asking whether that status has changed. She fills out one and sends it back, but they keep on coming for a couple of months. During that time, they reject every claim with the explanation that certain information has not yet been provided by the plan member. Some of the providers get worried, and we try to calm them down until the dust settles.
This year there were no questionnaires. Instead, her plan is rejecting every claim with the explanation that they have to know why Medicare rejected the claim. That's funny, Medicare couldn't have rejected the claim because they don't get it until after her plan processes it. Oh, I see. Suddenly, on January 1, they forget they're primary and think Medicare is primary.
So as soon as each EOB comes, we get on the phone, push the right buttons to escape from the automated system, wait for a human "representative," and explain that they're really primary. The representative says they will reprocess the claim. The providers still get worried. The other day I fielded a call from one and explained that we take care of the problem and they will get their money.
This is just one example of the hassles we get into because of the multiplicity of health coverage plans. And these are good plans -- I'm grateful that we can afford to pay for the "traditional plan" and don't have to fall back on the mercies of an HMO. Still, many providers are confused. Every once in a while I have to phone a provider to explain which plan is primary, or who gets the claim next.
For a supposedly advanced country, we sure have a stupid health care system.
posted by GrumbleGrouch at 2:09 PM
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