I heard this from a friend:
After hospitalization, the private policy they have refused to pay excess over Part A because they rejected Part B.
This is a big worry for me. My private policy is GREAT and I want to keep it. But not if there is a problem getting claims paid.
I'd really like to hear about your experience with continuing a private policy after Medicare kicks in.
Thanks.
Let yourself be happy.
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5 posts
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faithoverfear - Who do you know with myeloma?: me
- When were you/they diagnosed?: Sept 2014
- Age at diagnosis: 63
Re: Continuing private insurance after Medicare kicks in
Hello,
I'm interested in your situation because I will find myself in your shoes shortly. I have a couple questions: Is your private policy an individual policy, marketplace policy, group/employer policy, or on your spouse's employer?
When you say 'because they rejected Part B", you mean your friend rejected Part B, not your friend's insurance company?
I know there are rules about which insurance pays first, but you would think coverage would be no worse than either individually. Could it have been a deductible or out-of-network issue?
Good Luck
I'm interested in your situation because I will find myself in your shoes shortly. I have a couple questions: Is your private policy an individual policy, marketplace policy, group/employer policy, or on your spouse's employer?
When you say 'because they rejected Part B", you mean your friend rejected Part B, not your friend's insurance company?
I know there are rules about which insurance pays first, but you would think coverage would be no worse than either individually. Could it have been a deductible or out-of-network issue?
Good Luck
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Continuing private insurance after Medicare kicks in
Got an answer from my insurance agent and confirmed with a SHIBA advisor. Your insurance may be different, but this is a good place to start.
Here's the answer I got : Medicare approval does not mean that the service is covered by individual private insurance. Likewise, Medicare approval does meet the pre-authorization requirement for some treatments.
Bottom line: It takes a bit more work and communication with healthcare provider, but should not be a problem.
Here's the answer I got : Medicare approval does not mean that the service is covered by individual private insurance. Likewise, Medicare approval does meet the pre-authorization requirement for some treatments.
Bottom line: It takes a bit more work and communication with healthcare provider, but should not be a problem.
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faithoverfear - Who do you know with myeloma?: me
- When were you/they diagnosed?: Sept 2014
- Age at diagnosis: 63
Re: Continuing private insurance after Medicare kicks in
An transplant insurance coordinator at the cancer clinic explained the situation. This may help.
The question to ask private insurance is "Will you pre-approve treatment in case treatment is ultimately not covered per Medicare?" The key focus here is that Medicare does not approve or disapprove coverage until AFTER the expenses have been incurred. So there is no way to know which insurance should be primary until is may be too late.
Hope this helps.
The question to ask private insurance is "Will you pre-approve treatment in case treatment is ultimately not covered per Medicare?" The key focus here is that Medicare does not approve or disapprove coverage until AFTER the expenses have been incurred. So there is no way to know which insurance should be primary until is may be too late.
Hope this helps.
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faithoverfear - Who do you know with myeloma?: me
- When were you/they diagnosed?: Sept 2014
- Age at diagnosis: 63
Re: Continuing private insurance after Medicare kicks in
Follow up:
Yes, my private insurance will pay what Medicare does not. On the plus side: my private insurance DOES pay for genetic testing. Medicare does not.
On the minus side: a major hassle. To make this work requires many steps.
Not worth it otherwise.
One windmill down, how many more to go?
Yes, my private insurance will pay what Medicare does not. On the plus side: my private insurance DOES pay for genetic testing. Medicare does not.
On the minus side: a major hassle. To make this work requires many steps.
- Ensure provider knows that pre-authorization is required, which is not the expectation if Medicare is involved.
- Pay for the uncovered expense out-of-pocket.
- Submit for reimbursement.
- Wait 4Ever
Not worth it otherwise.
One windmill down, how many more to go?
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faithoverfear - Who do you know with myeloma?: me
- When were you/they diagnosed?: Sept 2014
- Age at diagnosis: 63
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