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Medicare Mistake: Big problem for Tucsonan

by on Jul. 06, 2012, under Health

Donna got her Medicare card in January, and it said her coverage would begin on April 1st, 2012. She enrolled in a Medicare Advantage plan, saw her doctors, and had her prescriptions filled under Part D.  On July 5th, she received a letter from her Advantage plan saying Medicare informed them that Donna does not have Medicare coverage.  What???

Donna got Social Security Disability back in March of 2010 and had to wait two years to get Medicare. That’s the rule. A person gets Medicare the 25th month after their Social Security Disability payments begin. Fortunately for Donna, she and her husband had health insurance, and they continued it until Donna got Medicare. As of April 1st, Donna dropped her health insurance and moved over to Medicare.

After getting the shocking letter from her Advantage plan, Donna called Medicare to ask what the heck was going on.  She was told something along the lines of, “Oops, we made a mistake”.

According to Medicare, Donna’s start date should not have been April 1st, so they changed her record and canceled her Medicare Advantage plan. They told her she doesn’t get Medicare until March 2013 because they found in their records that they had made a mistake calculating when her disability status began. What???

Apparently, Donna has not had any health insurance since April 1st. Apparently, her medical and drug bills may not be covered for the last four months. And apparently, Medicare doesn’t give a hoot about Donna’s dilemma.  Donna was told she can appeal this decision, but nobody could tell her how long that would take.

In fact, Donna has letters from Social Security from 2010, telling her she was awarded disability benefits as of March that year. In fact, the letters state that her disability was effective as of October 2009 and she would get back payments that were due to her from the period of October 2009 up to March 2010. In fact, she received those payments. Apparently, Medicare now wants that money back. What???

Donna is in shock – and she should be. She dropped her health insurance four months ago and cannot get it back. Given her health condition, she is probably uninsurable.  Medicare made a mistake and Donna has a big problem – and Medicare does not care that their mistake (if there was a mistake) has left Donna at risk of running up huge medical bills if she gets sick or injured and has no health insurance. How can this be???

I told Donna to contact Congressman Ron Barber’s office to ask for help. There is someone on his staff who deals with Medicare and Social Security problems all the time. That person can help Donna – but I don’t know how quickly he can get her problem resolved. In the meantime, what does she do? She can apply for health insurance and see if she gets accepted and at what cost. But how long will it take to get her application processed if the insurance company needs to review her medical records? And of course, it is highly likely that she will be denied coverage due to her pre-existing condition.

This is an amazing and shocking story. I sure hope it gets resolved quickly.

 

This entry was posted on Friday, July 6th, 2012 at 8:30 am and is filed under Health. Tags for this post: , , , , . You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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  • Dennis Byron

    I’m working on a similar situation right now.  Post the answer when you find out. 

    What I found at two different supposely unimpeachable (or is it impeachable) government sources (one the Medicaare and You Booklet, one the CMS handbook for SHIP volunteers) was two different answers:
    – One said (basically) Medicare was available two years after the disability happened
    – One said (effectively) that it was available two years after the disability was approved or as you said alternatively “after  the payments begin.”
    When did she get the award letter and/or her first “check?”

    (As an aside, it’s got to be one or the other  so she must be close to being eligible by some bureaucratic rule even if the later date is the one Medicare recognizes.  It might be better to just  apply for Medicare like none of this ever happened –  and then push the appeal.)

    • Denise_Early

      She has been told she will get Medicare in March 2013 – but she clearly met the 24 month-wait rule. And to make things worse, she now has no health insurance and probably will be rejected if she applies for coverage.

      Medicare gave her the card and now says, “oops, we shouldn’t have done that”.  She needs prescription coverage and she has incurred medical bills in the last four months thinking she was covered by Medicare. She never would have dropped her own health insurance without having Medicare.  Medicare should admit their mistake and should not have canceled her.

  • OllieWood

    And the author of this column believes dealing with the Federal Government, Obamacare, will be better than what we now have?
     
    Dealing with a Monopoly in healthcare is the worst possible option. 

    • Denise_Early

       In case you haven’t been paying attention, Ollie, Obamacare leaves health insurance in the hands of insurance companies. There is no monopoly in the under-65 market.  Now, when it comes to Medicare, there is a single-payer and that is Medicare. I guess you could call this a monopoly.

      I am dismayed that Donna is the victim of a bureaucratic screw-up, and I am concerned for her that Medicare/Social Security is so large that she will get lost in the shuffle. But I also know that insurance companies are very big bureaucracies as well, and they are no better than government agencies when it comes to customer service.

      I will be interested to see how Donna’s case is handled. She says she’s going to Senator McCain’s office on Monday to ask for help. I’ll let you know how things turn out.

      • OllieWood

        Medicare is not a complete monopoly.  With Obamacare attempting to defund Medicare Advantage, it is moving quickly in that direction.

        You are making a very broad statement when you state that “insurance companies are very big bureaucracies as well, and they are no better than government agencies when it comes to customer service.”  In a Medicare environment, the members can take their Medicare Advantage business elsewhere, at least, once a year.  One can’t do that with Medicare.
         
        I am paying attention.  I am an independent insurance agent and have to deal with Social Security and Medicare screw-ups continuously (as recently as this week).  Without competition, we have nowhere else to turn.

        • Denise_Early

          I’ve written many pieces on Medicare Advantage and how it’s not going anywhere but up in terms of enrollment. That’s why Wellpoint, United and other big players have paid billions of dollars buying smaller MA companies over the past year. There are too many people already enrolled in MA plans to get rid of them.

          I see the MA model as the future of Medicare – but these plans should be saving Medicare money, not costing it more than the inefficient fee-for-service we call “original Medicare”.

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