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Insurance Problems?

SJL
I picked up my Cobra at work, & made all payments, through 4/27/08, when the Cobra was due to end. On 4/29/08, I received a letter from my Cobra Insurance Co., saying that they were refunding my payments, from 7/1/07, as I was eligible for Medicare at that time. Of course, a huge stack of bills, totaling over 170,000 was included with the check. I am 64.


After researching, I find out that I had to elect Medicare B? I was never told this, and therefor I have no paperwork on it. I did go to the SS office when I received a notice that I had Medicare Part A, which they automatically enroll you in after 24 mths. of Cobra, but I elected not to pick up Part B, as my Cobra covered Dental, Vision and Health. At this time again, I was not told that I had to sign up for Part B.

My Insurance Company received and cashed all of my payments. Obviously someone dropped the ball and I assume that it was my Ins. Co.~~or possibly, Medicare just found it. On top of all this I had approval from my Ins. Co., for all treatments that I had.

I have been told that the only thing that I can do is to file an appeal? Has anyone experienced anything like this or know of a GOOD Attorney, specializing in Medicare? I live in FL.
SJL
5 Responses
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96938 tn?1189799858
You might have to do some good 'ole hepatitis-like reseach. Look for the state deaprtment of insurance regulation at myflorida.com.  You are going to have to weed through a lot of property insurance related stuff to find medical-related stuff.  In addition, you will likely see some references to go to medicare.gov.  Good luck Sandy.  By the way, the $177K, do those represent the amounts that were ALREADY paid to the medical providers by an insurance Co?
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SJL
I am not sure at this point. On the individual explanation of benefits sheets, of which they included approximately 30, the ones dated in Feb. & March of 08 showed a discount that has been posted and then they show a total which is listed under patient responsibility.(it appears to be 50/50.)

I have had 6 rounds of Rituxin, attempting to obliterate the Cryo. My last Cryo test showed that it was gone? Each session cost $19,631!!!!! I am treating at Shands and all of my treatments had been pre-approved from my case mgr., which co-ordinates with the Insurance Co??

On my last(6th.) treatment date,(which was Friday 4/25,) they had me all prepped for the treatment, when the Financial Services Mgr., came down and told them not to start the treatment, as they had not been paid for the previous treatment, which was on 1/08. He then called and got the approval from my Cobra Ins. to continue with the treatment.On these Explanation of Benefits, which they just sent,their are 5 Rituxin treatments which show that were not paid, which would total $96,805. The rest are Dr's, Labs,X-Rays, etc. So, even though Shands told me directly that they got approval from Cobra, which I know they did, as I overheard the conversation, now, it appears that if they did indeed pay them for 5 treatments, that they will get it back from the hospital? All of this makes no sense to me. I talked to Medicare yesterday and they said that the way this is being handled is legit, as law says that once you are able to collect Medicare, your Cobra is no longer available??? This was never told to me orally or in any written communication.

Of course, Shands was not in my immediate ins. plan, but they have a professional discount as they(Ins. Co.), are a self insured Hospital Campus, in Orl.

The only thing I know to do is to hire an attorney famaliar with Medicare.I still have the Hep C and intense Neuropathy, which is causing huge problems with my mental capacity. It has probably taken close to an hr.,attempting to explain this issue to you. I have until 5/22, to do an appeal process.

Thank you so much for answering, it means alot!
SJL  
Helpful - 0
374652 tn?1494811435
Oh Gawd you pore thing.  I live in NM and contacted the Public Regulations Commission here to file a complaint against Blue Cross in relationship to my insurance being cancelled before I was fired from work.  It seems they investigate if you have a complaint and in your case hopefull will force your insurance co. to look into this.  
I am so sorry, maybe you can look into legal aid and see if they have any recommendations for a medicare attorney.  I would also see if you can get any help from the Public Health Dept.  I dont know why I'm saying this, except they deal with hep c and maybe they have some leads.  Also is there a Hep C support group? Maybe Shans will have the name of one.  Best of luck,  why oh why dont we have universal health care here?  Greed. someone said we could never support it, well I dont believe that for one minute.  I think if some of our "priorities" were rearranged we could figure it out.  
M4now
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Avatar universal
I received a letter from my Cobra Insurance Co., saying that they were refunding my payments, from 7/1/07, as I was eligible for Medicare at that time. Of course, a huge stack of bills, totaling over 170,000 was included with the check.

It would seem to me that you might need a lawyer from what has been said. If you had paid the cobra since 7/07 and they sent you a letter and bills prior to that point and then from that point to the present returned payment. Is there a office for the ageing in the county in which you live? Or Contact your States Attorney Generals office in your state and they should able to help or point you in the right direction because this does not sound right at all.

jasper
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Avatar universal
SJL
Thanks for the info~at this point I have an appeal written and ready to send it to anyone & everyone. If you or anyone has any suggestions, please~I will try anyone and anything to attempt to reconcile this.
SJL
Helpful - 0
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