Can you get dropped from Medicare?
As if I was not having a bad enough day at work yesterday, I get a call from the urologist that my 90 year old father has been seeing for the past year and a half saying he was there and his medical insurance was being denied. He has Medicare and a supplemental. Would Medicare just drop someone? I get home from work and call Medicare and after being on hold for 20 minutes they tell me that they really can't tell me anything because they don't have me listed as a contact. I do have POA but to be made a contact I have to fill out a bunch of forms and have my father write a letter then send that off. I told the woman on the phone that quite frankly I don't have the time to do that. I am happy to send them a copy of the POA but that is it. I have been down this road with one of my father's banks. It ended with me spending an entire vacation day sitting in the bank getting it all straightened out. I called the supplemental insurance company and they couldn't do anything without me having his card in my hand which I don't have. My father has completely checked out with taking any responsibility for himself. His usual line to any one is 'my daughter takes care of that'. I do handle his finances but medical is more that I can deal with. All I wanted to find out is if he still has medicare coverage. How hard should that be? Anyone have any tips to find this out?
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I would do a conference call with dad, Medicare and yourself. You need to have copies of all of your dad's insurance cards, at the minimum.
Who do propose to deal with his medical issues? Do you have siblings. Have you thought about having dad hire a geriatric care manager?
There comes a point where our elders can no longer go to the doctor alone.
Assisted living takes him to his doctor appointments. There are no siblings. I have no issues with calling and trying to straighten this out but when agencies refuse to talk to me I don't know what the next step is. I am not retired and have literally no time to take off to deal with any of this. When I spoke with the woman at Medicare she just ran off a laundry list of things they needed for me to fill out, however it was not a exact list of what I needed....no specifics. I have already dealt with this before with his bank. I filled out everything they sent to me and returned it immediately only to have them send me even more forms or claim they didn't get them (yet I did notice some changes so they had to have received them). It wasn't until I took time off and spent several hours in a branch with someone who finally knew what they were doing for this to get resolved. I am not in a position to do that right now and even if I was I wouldn't know who to contact.
Where would I get a geriatric care manager? Dad is very hard of hearing so a conference call would not work. I need guidance on what my next step should be.
Your dad is amazing if at 90 he has been handling his insurance to the point that you have never had to be involved before!
Just trying to think what might have gone wrong.
There are three parts for over 65 for Medical care in the US.
Hospital. Doctors. Drugs. ( this is over simplified but complicated subject).
PT A of Medicare is for hospital care. It’s available to all over 65 US citizens paid for by the government. You can’t be dropped from this.
PT B is the portion of Medicare that is paid for by the individual. This pays for the doctor visits like the one who called you. Listed as Part B Medical on your dads Medicare card. You can be dropped from this for non payment. If you don’t have Part B you can’t have a supplement plan.
At 90 the usual procedure would be that your dads Part B premium wouid be deducted from his social security each month.
My aunt is 91 and $134 is deducted from her social security each month for her Part B. So as long as she is getting SS her Pt B is paid.
The supplement plan is paid for by the individual directly and can be direct pay from his bank account and the drug plan is paid for by the individual/direct pay from his bank account. Depends on how he has it set up.
All separate policies usually from separate companies.
Since the doctors office said his insurance is not in effect my first thought was perhaps his payment didn’t get made but as mentioned already the Part B usually comes from the social security so that doesn’t make sense unless dad didn’t get his social security this month??
Is it possible dad cancelled his traditional Medicare by signing on with a Medicare Advantage Plan?
These plans can sound pretty enticing on the ads. No premium to pay. All inclusive etc.
If you are already set up with his bank, why not call them and see if payments are being made out of his bank account for his supplement.
See if his social security auto deposit is $134 or so more in January than it was in December. My aunts deposit hits about the 4th of the month.
If he ventured off into Advantage land then his urologists might not be covered under his new plan.
I think Advantage Plans require he see networked doctors, have to go through primary doc for referrals etc.
I sure hope I’m wrong.
I think if I were you I would write that letter right now and see if you can fax it in to get to the bottom of this ASAP.
If he has signed up for the Advantage plan then he may have a hard time getting his previous supplement back. Medicare Pt B won’t be the problem. The supplement will be the issue if I understand it correctly.
It’s easy to go from traditional Medicare to advantage. Not so easy to go from advantage to traditional.
I remember another poster saying her mothers ALF was offering an Advantage plan. She was trying to decide what to do.
A call to the office of your dads ALF might be beneficial to see if they were doing that. And it might be alright if he did that. I dont know. You will need to compare the policies.
Let us know what you find out.
ikdrymom said he had been seeing the urologist over a year. Plus the dr called her to say the insurance was denied.
lK - did this just happen? Like since Jan 1st? If so, I’d bet his urologist as a vendor has changed thier participation with Original Medicare or their “in network” status within an Advantage plan. Changes go into effect usually Jan 1st. The Advantage plans seem to send out info on upcoming changes couple of times the months before along with a quite lot of other stuff, like promoting Silver Sneakers type of programs. If he lives on his own, does he actually pay attention to his mail? Original Medicare puts notices for you to check provider changes on the statements CMS sends out when benefits get paid - so for Original it’s more on you to keep up with changes; if you don’t, & see a vendor that no longer is on Medicare then it’s on you to pay. Original also snail mails out a book with Medicare info by region and some have participating vendors listed. Again it’s on you to go through and find out who participates.
Where I live there’s been a real realignment of providers as a new big health care hospital system opened recently. Less MDs crossing over into multiple networks. Which has meant lots of folks facing bills who never ever had one before as thier old MD is now out of network. Big enough of an issue that the TV stations have covered it as an item. If dads docs are out of network either he pays the extra or you’ll need to help him find new MDs. If this is what’s happening & he can’t seem to figure it out, try explaining it as a sports team analogy..... dad needs to stick with the players on his insurance team. Dad might be a UT longhorns super fan but for now he’s just going to have to go to only Aggies games.
Go back to the doctor and ask if they used the right code when filing. You wouldn't believe how often 'accounting' uses the wrong codes and thus payment is denied.
I have had to deal with this too many times - but I learned not to pay, make them check the codes they used.
Since Medicare comes off the top of your Social Security - I have never heard of anyone's Medicare being dropped. This doesn't mean it can't - but I've never heard of it.
I appreciate all the responses to my question. I was so distraught because I had no clue where to even start in dealing with such an issue. Will be getting copies of his health cards next time I see him.
Make a photo of his cards front and back on your phone if possible then you’ll always have them with you.
The overarching question is, how many docs and doc visits does dad need at 90?
When I moved my mom into IL at 88, the geriatrics doc there took her off most of her meds and mom did just fine. At some point, less is more.
* Get a copy of your dad's social security card, medicare card, and supplemental insurance card. If you take a photo with your cell phone and keep it in an album titled "Dad's med" you will be able to find it when needed.
* Set up a separate email account for your dad. Give this email to all of his providers, banks, and any other organization that sends him bills or information. This makes it more clear that some item of information has come in for him.
* Get online access to your dad's bank account(s). Go online and see what you have to do. This gives you fast access to where his money is coming from and going to, such as a supplemental insurance account. Check the accounts every week.
* Contact the supplemental insurance carrier and explain that you are the daughter and your dad's age and his hearing difficulties. Find out what you need to do for them to speak with you at any time. My mom has SCAN here in Southern California. We are all set up with them. When I call I tell them that I am calling on behalf of my mother, I give her name and age, and I state that I am her daughter and give my name. They ask a confirming question and we go from there.
* You need to do this with every Dr. and I know that takes some time. If the Drs. are in a network, start with the office familiar to you and find out what it takes for them to speak with you.
* Buy a spiral notebook and write down everything you find out from each person, Dr., or carrier. You'll have everything in one place. Print out those photos of the ID cards and tape copies inside the cover of the notebook. Ready reference.
* I know it seems overwhelming and at times it is just darn way too involved. Nevertheless, the option is that your dad could end up with no or limited coverage at a time he needs it the most and then you will have a big mess on your hands.
* Remember key words and phrases "why", "I'm not clear about that, would you explain it again", "what are my dad's (or my) options", "what do I need to do next". Always get a name. If the information seems odd, then call back some other time and ask the same question.
* Your dad's response that his daughter takes care of everything is the common response. He's lost track of what to do and how to do it and just knows that he has Drs. and some type of insurance. You are "it". I've been there and it is frustrating but the options are minimal.
I have had no issue with any doctors speaking to me. In fact they tell me more than I want to know. His supplemental would have spoken with me if I had his card to read from. Just medicare and that one bank.
It is very overwhelming for me to deal with the medical aspect. I am fine with the financial part. It never fails that he has a 'crisis' when I have a full plate with work and home. There comes a point where you just have nothing to give anymore. I like to solve problems but with an elder their problems never stop.
When I first started taking care of mom, we did everything...POA, Advance Directive, and her will. I am her decision maker, point of contact, representative for anything and everything. I am even her social security payee and it has made life easy as far as being able to talk to companies. I had to, one of the first things to go was mom's speech. She speaks gibberish.
I have sent it out so many times, I don't remember how I did it with Medicare. It was either by fax or mail, but I always do it the same.
I have several copies of the POA handy and a basic letter saved on laptop.... mom's name, SS# or account #, DOB, mailing address, and mom "appointing me POA because she has Alzheimer's. Please update her records. If you need more info, please feel free to call me....."
Than I would wait about a week and start calling to see if they received my letter. I don't remember having to send it more than once, but I am ready if I needed to.
Medicare can be very frustrating but don't give up. Sometimes you just have to walk away and take a breather. And then go back until you get what you need. There are people at Medicare who know what they are doing.... you'll get the right person!!
that is for hospitalization.
Part B is for Dr and tests.
Does he have a private insurance for part b or an all in one plan or something
similar with an insurance company. Is it paid for by auto debit or does it need
a check mailed in?
Ask the dr who was paying them before this denial, is the same provider that now denied coverage --- call that same provider and find out what is going on.
Also was it denied because he doesn' t have coverage, because the procedure wasn't covered or because a deductible hasn't been met?
Either way --- good time to make copies of all of his id cards to keep in hand, and have him authorize you on a conference call with you, him and provider on the line to talk until you can get a paper permission POA or their own permission form signed and into their records. If you live far away, ask sibling, family member or trusted friend to go make these copies for you, and have more than one set on hand for you.
OR if Dr's office knows you and has HIPPA forms giving permission for them to share his info with you, ask them to fax or email you a copy of the cards they have on file for him.