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 Posted: Mon Nov 14, 2011 5:27 pm Post subject: Health Insurance battling who should be primary vs secondary |
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I have two health insurances
1st one is via my former employer while on a long term disability plan. I am no longer employed with this company however my health benefits are still paid as long as my former employer disability sponsor deems me "disabled"
2nd is through SSDI. I was approved for social security in 2009 and decided to choose not to go with the standard medicare plan A and B plan.
The two insurances are disputing who should be primary the Medicare plan feels they should be secondary and the Verizon sponsored plan feels they should be secondary and in the mean time my various doctors are about to send my claims to an outside collection agency since I am unable to pay.
I am very frustrated and have had both insurance companies on the phone (using 3 way) and thought the issue was resolved after a 2 hour debate on the phone where both representative from each provider were arguing and consulting with their supervisors. To make this situation even better both insurances companies are the same (BC & BS) Help me someone what can I do?
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stuck in the middle
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| Posted: Tue Nov 15, 2011 4:51 am Post subject: |
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In my opinion you should make the SSDI your primary policy. Get the help of an insurance advisor and discuss, what should be done to solve this issue.
If the insurer is the same then why is it a problem? get your agent to talk to the insurer. A professional should talk to the insurance company to make them reimburse through any of the policies they think is just.
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Voidolove
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| Posted: Tue Nov 15, 2011 7:54 pm Post subject: |
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Thanks I have spoken to both division of BC & BS. I have now been forced to file a complaint I have had it with both of them. Reading the FAQ's on medicare's website listed examples of which is primary but my situation is similiar to one listed however I am no longer employed by my former employer so I guess it may not apply but I think Medicare is using that example in determing they should be secondary and not primary.
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stuck in the middle
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| Posted: Wed Nov 16, 2011 5:52 pm Post subject: |
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You should fight it out, as you can keep two policies from the same company they can't just argue to avoid settling your claim. Consult an insurance advisor to guide you through this.
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anonymous007
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| Posted: Tue Nov 22, 2011 3:26 pm Post subject: |
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I don't know why it is necessary to have two policy at the same time, i think you should quit a policy and everything will be fine.
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stevenricherd
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| Posted: Mon Jan 02, 2012 3:51 pm Post subject: |
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| You can consider filing a complaint with your state insurance department. They would probably take it up as ‘unfair claims practices’ and discipline them in case they are arguing to avoid settling your claims. |
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Heller
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| Posted: Tue Jan 03, 2012 2:23 am Post subject: |
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| Quote: | 1st one is via my former employer while on a long term disability plan. I am no longer employed with this company however my health benefits are still paid as long as my former employer disability sponsor deems me "disabled"
2nd is through SSDI. I was approved for social security in 2009 and decided to choose not to go with the standard medicare plan A and B plan. |
Everyone who answered this post above has it wrong.
You have health insurance to pay hospital and doctor bills. Your employer is continuing to provide that to you due to a work-connected disability. You state that you "chose not to go with the standard Medicare plan A and B", which could mean you do not have "two" health insurances.
Social Security Disability Income benefits do not pay hospital or doctor bills.
Now, if you actually meant that you chose a Medicare Advantage HMO, you DO have Medicare A & B but have, instead, substituted a "Part C" Medicare Advantage for that -- it is not "through SSDI" and it has nothing to do with SSDI except that you have been receiving SSDI payments for more than 24 months -- then your Medicare plan is, by default, secondary to an employer-sponsored plan. This is federal law, and has nothing to do with the state.
No one has commented on this, and everyone has given you misleading information, with the possible exception of filing a complaint with the Dept of Insurance.
Contact your employer-sponsored health plan and ask why they have not paid the claims. That is your primary insurance. Medicare/Medicare Advantage will only cover the excess medically-necessary expenses.
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MaxHerr
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