Just when you think you have Medicare setup and you no longer should worry, your mailbox starts to fill with claim denial letters. Post enrollment Medicare mistakes can sometimes happen to cause denied claims, unexpected bills. Here are some tips on how to avoid them.
As more and more people, these days continue to work past the age of 65, plus a number of people are delaying their Social Security (SS) income benefits due to continued working incomes. If this is the case Medicare Part B premiums will be billed you with quarterly invoices instead because there is no SS check to deduct from.
Overlooking a bill from Social Security is easy to overlook within the mountains of Medicare beneficiary mail received each year. The result of being late on your bill is catastrophic.
When this happens, Social Security will revoke your Part B for non-payment. Then your Medigap carrier is notified and quickly cancels your Medigap plan leaving you without coverage. No coverage for doctor visits, outpatient services, medical equipment, lab work, surgeries, dialysis, chemotherapy and other very expensive services.
Worse yet you will have to wait for the next (GEP) General Enrollment Period to enroll. Jan 1st – March 31st of each year with coverage starting the following July.
TIP: When enrolled before taking Social Security, setup a bank draft to avoid nonpayment.
Calling into Medicare to confirm your primary coverage may prevent any denials or hassles.
Typically, your employer will notify Medicare accurately informing them you will no longer be working for the company. This will work about 95% of the time which tells Medicare to begin paying as your primary insurance.
If your employer fails to properly notify Medicare, or even worse, occasionally you can be claimed the following year after you’ve been gone. A new round of denied claims can be the result.
TIP: Call Medicare, 1-800-MEDICARE one you have left your employer. Verify they show Medicare is, in fact, your primary insurance.
Easy to make Medicare mistakes can happen. If your primary coverage is Medicare, you give your Original Medicare card as well as your Medigap Card to your service provider.
If you’re using a Medicare Advantage plane, the Advantage Plan pays instead of Medicare. People forget and give their Original Medicaid card and (Medicare will deny all your claims) because the bills were supposed to go to the Medicare Advantage Plan Company.
Tip: When you’re enrolled with a Medicare Advantage Plan, only give providers the Advantage card. Put away your Medicare card and keep it in a safe place. If you change your mind and drop your Advantage plan then you will be using the Medicare card.
An additional type of mistake is when beneficiaries give Medicare cards for any drug related expenses as well as vice versa by giving a Part D card for a non-drug related expense.
Just treat your Part D drug plan as your “Pharmacy Card” which you only use when you’re at the pharmacy.
TIP: Usually your Part D plan has the word RX on the card somewhere. Use this card when purchasing prescriptions at the pharmacy.
Never pay the provider your deductible during the time of treatment, even if the provider requests it. There is a proper procedure for this.
Doctors do not need to collect deductibles at the time of service.
The reason is you may have more than one visit on the same day to different providers, doctor, lab work, etc. Medicare applies the deductible to the first service processed. So, depending which bill is processed first, the doctor or the lab work may have to bill you for the deductible. This is unknown until Medicare processes the bills. So never pay the deductible up front.
This can also cause problems if you get charged for deductibles twice and have to show proof that you have already paid your deductible to get a refund. If this is at a hospital, the number of different providers increases which can cause more problems in finding out who paid the deductible. Again, never pay the deductible till the bill is processed.
TIP: Make your doctor aware that a deductible is owed but he must bill you. You can pay the doctor what is owed after Medicare has paid the claim and sent a notice to you.
Medicare has many great preventive care benefits that are fully covered and Medicare will pay 100% of it. Including cardiovascular disease, aneurysms, and diabetes screenings. Also, common cancer screenings, mammograms, tests for lung cancer are included. A full list of benefits can be found on Medicare’s website.
Proper billing codes for what’s covered by Medicare. So, you know which tests to expect coverage and which will be out of pocket. Always consider that while specific screening s may be covered there could be related services that are not. This is something seen often with Advantage plans.
TIP: Use your primary doctor for your preventive care. For additional preventive and or wellness care form other facilities, always confirm with them what will owe prior to the procedures.
In the fall of each year, Medicare has its annual election period, also called the (OEP) Open Enrollment Period. During this time from October 15th – December 7th you can make changes to Part D, drug plan, or Medicare Advantage plan if enrolled. This period exists because the plans benefits change each year with changes in premiums, drug plans may change, etc. You should receive a letter from carrier called the Annual Notice of Change.
TIP: Add a reminder to your calendar for September 30th to review your Annual Notice of Change packet. Then compare the differences in benefits form currently to upcoming. Always consult your insurance agent for questions concerning any change.
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