What do I do after Medicare denies medical claim?

August 29, 2018

Dear Toni,

My husband recently was laid off from his job and I needed to sign up for Medicare. I only signed up for Medicare Part A and not Part B when I turned 65 because his company insurance was excellent. When I went to the local Social Security with the Request for Employment Information signed by my husband’s HR department to sign up for Medicare Part B. I asked if I needed to do anything else and I was told I was all set. I received my new Medicare card in the mail with both Medicare Part A and B dates a few weeks later. It was not until I went to the doctor in July and had my claim denied that I found out my husband’s company insurance was still listed as primary. Now my nightmare begins … The insurance company said that I had to call Medicare to update Medicare’s system. Medicare said it would take 10 days to update the system. What do I do? I have no coverage because the company insurance is still listed as primary and neither Medicare nor my Medicare Plan G will pay.

Janet from Cypress


In the past few weeks, the Toni Says® Medicare hot line has been receiving questions such as yours from those past 65 who left employer group benefits and are having their Medicare claims denied. Medicare still has the employer group health plan, whether it is UHC, Cigna, Aetna, etc., as primary insurance which supersedes Medicare and the Medicare Supplement or Advantage plan applied for.

There is a simple process that those leaving employer group health plans whether you are the employee or the covered spouse and enrolling in Medicare should do to verify which is considered primary insurance. Also, you need to inform Medicare that Medicare should be primary and you or your spouse are no longer covered on an employer group health plan.

The verification process to discover what is your primary Medicare insurance is below:

1) Visit www. mymedicare.gov and register for a My Medicare.gov account.

2) View what is in your MyMedicare.gov account and verify that your information is correct. Knowing this information, you will be able to view what Medicare is viewing while you are discussing your issues such as what plan you are using, what Medicare Part D plan you are enrolled in, claims and other Medicare issues.

3) If you see that your employer group health plan is still primary after you have enrolled in your and/or your spouse’s Medicare Part B, then call the Medicare Benefits Recovery Center at 1-855-798-2627 and advise the agent that you and/or your spouse are no longer enrolled in the employer group health plan.

4) The change from group health insurance as primary insurance to Medicare as primary insurance is estimated to take 48 hours.

5) Need help with these types of issues, call the Toni Says® Medicare office at 832-519-8664 and an agent will assist you with finding an answer to your Medicare problem.

Because Medicare is using online more, we are advising all Toni Says® Medicare clients to open a www.mymedicare.gov account when enrolling in Medicare whether you are turning 65 with or without employer group health benefits. Medicare mails out the Medicare Summary Notice every 90 days. View it faster at www.mymedicare.gov.

Email Toni Says® info@tonisays.com for information or visit www.abbs4u.com.

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