Question from Stu:
Aaron, I’m looking to see if you can help me. I enrolled and was approved for Medicare Part B effective 6/1/23. I received my Medicare Card and have had deductions taken from my Social Security. Medicare has rejected all claims for physical therapy and flu vaccines I had after 6/1/23. When I call Medicare, I’m told Part B is in effect and the system shows no claims have been filed.
My providers tell me they have filed and received rejections saying I’m not covered by Part B. When I call Medicare, they just repeat that all is fine and there are no claims on file. About 3 weeks ago I received a letter from Medicare explaining I was financially responsible for all claims as I do not have Part B coverage.
I called Medicare again and was told all was good and no claims were filed. When I explained that I received a letter directly from Medicare with these rejections, they were surprised and said they would research it. I was told to expect a response in a week or less. That was two weeks ago and no response.
My question is do you know how I can elevate this? I need medical services now (potential hip replacement), but I can’t do anything knowing that Medicare has written me that I’m not covered and financially responsible. Any assistance you can provide would be helpful.
Answer:
This kind of issue is not uncommon. It may sound complicated, but the reality is there’s only a handful of reasons for such a disconnect between Medicare and Stu’s medical providers. Although Stu may feel like it’s impossible to get the problem fixed, I’m 100% confident the staff of The Health Insurance Store could solve it as we’ve done hundreds of times. It might take a couple phone calls or a few hours talking with Medicare, Social Security, and Stu’s providers. No matter how much time is needed, our clients never have to worry when issues like this arise because we don’t stop working until there’s a solution. That’s our commitment and obligation to our clients in return for allowing us to help them choose a Medicare or health insurance plan that results in a commission.
However, despite being a long-time reader of the columns, Stu chose to get his Supplement through another broker and is now reaching out to us, not the agent who got paid to enroll him, for help. This is a trend our staff are struggling to work through. Stu’s agent is responsible for taking care of his current dilemma. Sadly, many if not most agents don’t want to do the hard part, which is take care of clients AFTER the commissions are paid. The real work, the time-consuming work, takes place when a problem like Stu’s occurs. Or when Larry, age 80 and an 11-year client who came in to see me this week because he’s struggling to take care of his sick wife and needed advice and help. I called the Area on Aging with him and I’m hopeful they will supply Larry with some no cost relief attending to her at home to keep her out of a nursing facility. This is just one example of how we at The Health Insurance Store will go above and beyond
We are being overwhelmed by people who love my columns but are turning to other agents to enroll them in a Medicare Advantage Plan or Supplement. After some conversations with our staff at The Health Insurance Store, I’m very seriously considering discontinuing the columns in the Post Gazette and it also appears likely we’re going to have to make the decision not to work with people who only after they’ve been let down by another agent or run into a problem like Stu, call us. We can’t continue doing other agents’ jobs for them while they get paid, and we do their work with no compensation. We won’t be making this decision out of spite. It’s always been my goal to help anyone who asked for it. But it’s no longer sustainable and causing excessive stress for the agents and administrative staff as we find ourselves working 10-to-12-hour days, including weekends, to keep up. It’s also taking our attention away from those who did choose to allow us to initially advise and enroll them, which isn’t fair to people like Larry and our other loyal clients.
That being said, let me make it very clear that we will still be taking on new clients who are going on Medicare for the first time or are already on Medicare and interested in changing plans or companies. Appointments for consultations are always no cost. If you can’t make it to one of our offices, we can meet via a virtual internet meeting or by phone.
I think some people may not realize that I don’t get paid to write this column. In fact, I pay a large amount of money to have it published. Although we love to help people, The Health Insurance Store isn’t a non-profit or government agency. We depend on commissions to pay salaries and the many other expenses of running an agency. Please understand once you have an agent enroll you in a policy, unless you change plans and/or companies, the original agent will always get paid. Unfortunately, you can’t have your policy and commission transferred to The Health Insurance Store after the fact.
I’m not writing this to ask for sympathy. My staff and I will work through this and continue to assist new clients choose the best Medicare health and drug plans while ensuring we are always available for our current clients whenever they have questions or concerns with anything remotely related to their policies. What I’m asking is that you consider your choice of agent and agency wisely. I’m asking those who enjoy the columns and would like to see them continue in the PG allow The Health Insurance Store to advise and enroll you in a plan. We absolutely respect your choice to go elsewhere. However, if you do and contact us later with problems like Stu, please respect and understand we may not be able to assist you. I apologize in advance.
To prepare for the possibility that the columns will no longer run in the PG in 2024, I recommend joining our Facebook Page with the same title. They will continue to be published there. You can go on our website to join. Simply click on the banner that appears at the top of the home page.
Make An Appointment
If you would like to make an appointment for a no cost consultation to go over Medicare options, individual ACA marketplace plans, you’re an employer and would like a second opinion on your group policy, or are interested in life insurance, give us a call or email me personally at aaron@getyourbestplan.com. And keep the great column questions coming! Also, I am now licensed in over 20 states and able to help people choose and enroll in Advantage, Supplement, and Part D plans throughout the country.
Introducing New Facebook Group
Don’t forget to join our new Facebook group, “Ask the Medicare Specialist”, which has the same name as the column, where we post exclusive content and information. Go to our website, getyourbestplan.com, and click on the banner on the homepage to become a member. Thanks for reading everyone!
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.