Can you get dropped from Medicare?
As if I was not having a bad enough day at work yesterday, I get a call from the urologist that my 90 year old father has been seeing for the past year and a half saying he was there and his medical insurance was being denied. He has Medicare and a supplemental. Would Medicare just drop someone? I get home from work and call Medicare and after being on hold for 20 minutes they tell me that they really can't tell me anything because they don't have me listed as a contact. I do have POA but to be made a contact I have to fill out a bunch of forms and have my father write a letter then send that off. I told the woman on the phone that quite frankly I don't have the time to do that. I am happy to send them a copy of the POA but that is it. I have been down this road with one of my father's banks. It ended with me spending an entire vacation day sitting in the bank getting it all straightened out. I called the supplemental insurance company and they couldn't do anything without me having his card in my hand which I don't have. My father has completely checked out with taking any responsibility for himself. His usual line to any one is 'my daughter takes care of that'. I do handle his finances but medical is more that I can deal with. All I wanted to find out is if he still has medicare coverage. How hard should that be? Anyone have any tips to find this out?
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Your dad is amazing if at 90 he has been handling his insurance to the point that you have never had to be involved before!
Just trying to think what might have gone wrong.
There are three parts for over 65 for Medical care in the US.
Hospital. Doctors. Drugs. ( this is over simplified but complicated subject).
PT A of Medicare is for hospital care. It’s available to all over 65 US citizens paid for by the government. You can’t be dropped from this.
PT B is the portion of Medicare that is paid for by the individual. This pays for the doctor visits like the one who called you. Listed as Part B Medical on your dads Medicare card. You can be dropped from this for non payment. If you don’t have Part B you can’t have a supplement plan.
At 90 the usual procedure would be that your dads Part B premium wouid be deducted from his social security each month.
My aunt is 91 and $134 is deducted from her social security each month for her Part B. So as long as she is getting SS her Pt B is paid.
The supplement plan is paid for by the individual directly and can be direct pay from his bank account and the drug plan is paid for by the individual/direct pay from his bank account. Depends on how he has it set up.
All separate policies usually from separate companies.
Since the doctors office said his insurance is not in effect my first thought was perhaps his payment didn’t get made but as mentioned already the Part B usually comes from the social security so that doesn’t make sense unless dad didn’t get his social security this month??
Is it possible dad cancelled his traditional Medicare by signing on with a Medicare Advantage Plan?
These plans can sound pretty enticing on the ads. No premium to pay. All inclusive etc.
If you are already set up with his bank, why not call them and see if payments are being made out of his bank account for his supplement.
See if his social security auto deposit is $134 or so more in January than it was in December. My aunts deposit hits about the 4th of the month.
If he ventured off into Advantage land then his urologists might not be covered under his new plan.
I think Advantage Plans require he see networked doctors, have to go through primary doc for referrals etc.
I sure hope I’m wrong.
I think if I were you I would write that letter right now and see if you can fax it in to get to the bottom of this ASAP.
If he has signed up for the Advantage plan then he may have a hard time getting his previous supplement back. Medicare Pt B won’t be the problem. The supplement will be the issue if I understand it correctly.
It’s easy to go from traditional Medicare to advantage. Not so easy to go from advantage to traditional.
I remember another poster saying her mothers ALF was offering an Advantage plan. She was trying to decide what to do.
A call to the office of your dads ALF might be beneficial to see if they were doing that. And it might be alright if he did that. I dont know. You will need to compare the policies.
Let us know what you find out.
Go back to the doctor and ask if they used the right code when filing. You wouldn't believe how often 'accounting' uses the wrong codes and thus payment is denied.
I have had to deal with this too many times - but I learned not to pay, make them check the codes they used.
Since Medicare comes off the top of your Social Security - I have never heard of anyone's Medicare being dropped. This doesn't mean it can't - but I've never heard of it.
lK - did this just happen? Like since Jan 1st? If so, I’d bet his urologist as a vendor has changed thier participation with Original Medicare or their “in network” status within an Advantage plan. Changes go into effect usually Jan 1st. The Advantage plans seem to send out info on upcoming changes couple of times the months before along with a quite lot of other stuff, like promoting Silver Sneakers type of programs. If he lives on his own, does he actually pay attention to his mail? Original Medicare puts notices for you to check provider changes on the statements CMS sends out when benefits get paid - so for Original it’s more on you to keep up with changes; if you don’t, & see a vendor that no longer is on Medicare then it’s on you to pay. Original also snail mails out a book with Medicare info by region and some have participating vendors listed. Again it’s on you to go through and find out who participates.
Where I live there’s been a real realignment of providers as a new big health care hospital system opened recently. Less MDs crossing over into multiple networks. Which has meant lots of folks facing bills who never ever had one before as thier old MD is now out of network. Big enough of an issue that the TV stations have covered it as an item. If dads docs are out of network either he pays the extra or you’ll need to help him find new MDs. If this is what’s happening & he can’t seem to figure it out, try explaining it as a sports team analogy..... dad needs to stick with the players on his insurance team. Dad might be a UT longhorns super fan but for now he’s just going to have to go to only Aggies games.
I would do a conference call with dad, Medicare and yourself. You need to have copies of all of your dad's insurance cards, at the minimum.
Who do propose to deal with his medical issues? Do you have siblings. Have you thought about having dad hire a geriatric care manager?
There comes a point where our elders can no longer go to the doctor alone.
I appreciate all the responses to my question. I was so distraught because I had no clue where to even start in dealing with such an issue. Will be getting copies of his health cards next time I see him.
The overarching question is, how many docs and doc visits does dad need at 90?
When I moved my mom into IL at 88, the geriatrics doc there took her off most of her meds and mom did just fine. At some point, less is more.
I have had no issue with any doctors speaking to me. In fact they tell me more than I want to know. His supplemental would have spoken with me if I had his card to read from. Just medicare and that one bank.
It is very overwhelming for me to deal with the medical aspect. I am fine with the financial part. It never fails that he has a 'crisis' when I have a full plate with work and home. There comes a point where you just have nothing to give anymore. I like to solve problems but with an elder their problems never stop.
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