Tuesday, July 21, 2015

IBM Medicare OneExchange Reimbursement for Opt-Out Doctors

I wrote about this a while ago but thought it was worth another posting because it continues to be an area that is annoying and there is no place that I found on OneExchange's site to tell you what to do.
   
Last week I submitted two paid bills from a doctor that does not accept Medicare.  That is, the doctor has chosen to "Opt Out".  He doesn't submit his bills to Medicare for processing (and denial) and my supplemental insurance is a standard medigap so it will not cover anything that Medicare will not cover.  Sometimes retiree secondary insurance provided by companies (yeah, there are still companies that still provide group plan coverage) do cover procedures not covered by Medicare such as acupuncture.  These insurance policies often want the doctor bill to be processed and denied by Medicare before they will pay for the services. We lost that kind of coverage when IBM threw us over the wall to OneExchange but if you have a spouse who covers you with that kind of insurance, there is a way for you to submit the claim to Medicare yourself.  The directions are on www.medicare.gov.
          
I don't often go to opt-out doctors so I didn't submit the claim the exact way OneExchange wants it done.  Of course, they denied my claim.  They said I had to submit an EOB from my insurance company with the bills.  That's really clear direction!  What they want to see is how much the insurance company had paid because I wasn't clear on the OneExchange claim form that this was an opt-out doctor service.
     
A digression: an EOB is an Explanation of Benefits statement that comes from a private insurance company.  OneExchange is assuming, by using that phrase, that I either bought a Medicare Advantage policy or I have original Medicare and bought a secondary policy.  Neither might be true and, as a claimant, I might only have original Medicare coverage.  If so, then the only thing I'd receive is an "MSN" or a Medicare Summary Notice, which is the original Medicare statement that is sent quarterly from Medicare.  OneExchange uses "EOB" even when they mean "MSN". 
 
Back to the topic of the blog post.  There are no directions anywhere from OneExchange on how to submit an "Opt-out" claim. Here's what to do:
    
  • You need a bill from the doctor that is marked paid in full.
  • You need the receipt for that payment (credit card or check) so do not pay the doctor in cash unless they can give you a separate receipt with your name on it! If you paid from an account, you must prove the payment is from an account that belongs to you so be sure there is some identification on the statement you provide that names you as the payer. I ran into this because when I print out my credit card transactions there is no owner name on the print out for a single item.  What I do now is make a copy of my credit card, black out all the numbers but the ones that match the print out and submit the card image with the claim to prove it was from my account.
  • You have to write on the OneExchange claim form that the doctor has opted out of Medicare. For extra measure, I also write it on the doctor's statement.  
 
I forgot to write the opt-out information on the claim form (I only wrote it on the bill).  So, of course, I had to resubmit the claim. 

For most of this year submitting claims to OneExchange has been less irritating for me that last year.  Nonetheless, it is still annoying.

Saturday, June 13, 2015

IBM Medicare OneExchange Original Medicare Out of Pocket Costs

I decided to try to decipher a bill I received yesterday from a provider.  It is almost impossible figure out how something is billed, why Medicare paid what they paid and what is due from the patient. It took me a couple of hours but I finally understand the bill.  I went back and forth between my MSN statements, my medigap EOB statements and the provider bill (which was particularly unintelligible).
 
The complicated Medicare billing is brought to us by CONGRESS!  They set the fee structure and they regularly fool with it.  Remember the ugly spate of legislative activity in 2013 that resulted in sequestration?  That resulted in a 2% reduction in provider payments. However, it did not change the patient coinsurance payment.  The easiest way to explain this is by way of example.  Suppose the Medicare approved doctor fee for a service is $100.  Prior to 2013, Medicare part B would have paid the doctor 80% of the fee or $80 and the patient would pay 20% of the fee or $20 (assuming the doctor accepts assignment).  HOWEVER, because of the 2% reduction from sequestration, now Medicare pays the doctor 2% less (on the $80) or $78.40.  MEANWHILE, the patient still owes the doctor $20.  So, when you get a bill from the doctor that shows how much Medicare approved, how much Medicare paid and how much you owe thank your congressional representatives for making it almost impossible to understand.
 
I know I keep harping on how congress niggles with Medicare but it is so important to all of us to know how this Medicare piggy bank keeps being raided.  I just read something about how the TTA (Obama's fast track trade) bill tried to imbed another cut to Medicare providers buried in the bill to pay for the cost to implement it.  There was going to be another 0.25% cut to providers.  Happily, the house voted to remove that provision. But it was only after the medical community raised a stink.  In an earlier post, I mentioned that resident doctors are paid salaries out of the Medicare budget.  Everyone benefits from the services of these beginning doctors.  Meanwhile, legislators scream about the high cost of Medicare.
 
Back to the topic of the blog - patient out of pocket costs in original Medicare.  Congress structured a payment process that varies between coinsurance and copayments.  Once again, it couldn't be more confusing.  What's the difference?  One is a percentage (coinsurance) and the other is a fixed amount (copayments).  Most of the time copayments are used for outpatient hospital related services and coinsurance is used for doctor related services.  Again, an example is the easiest way to explain it.  Suppose you have a cast on your arm.  If you go to the hospital as an outpatient to have the cast removed, you will pay a copayment.  So, if the hospital fee is $150 to take the cast off, your copayment might be $40.  The amount of copayment depends on the city where the hospital resides.  If you go to a doctor, it's an office visit so the service fee is likely to be less.  Let's say it's $100.  Your payment would be a coinsurance of 20% or $20.
 
Generally speaking, it is more expensive to have a service rendered by a hospital than by a doctor. But not always. The obvious case of WAY MORE EXPENSIVE is using the emergency room for services.
 
Medicare has a wonderful publication that describes original Medicare costs.  It came from the www.medicare.gov site:
 
https://drive.google.com/file/d/0B83wVKnNLtjtSlg2aFJfQXhYbHM/view?usp=sharing

It's also important to remember original Medicare has no cap on out of pocket costs.  The only way to get an annual cap on out of pocket costs is to either buy a medigap plan or buy a Medicare Advantage plan.  This year I have been using a medigap K plan to have a cap on out of pocket costs.

If you are using a Medicare Advantage plan none of the rules described in the above publication apply.  Medicare Advantage plans are required to cover the same services as Medicare and are required to stay within Medicare's fee schedule. However, they can restrict who provides the services, pay providers less than the Medicare approved fee, and/or shift more of the fee burden onto patients.  Demand to see their cost sharing breakout for all procedures.  They are famous for having low copayments for primary care doctor and freely disclose those payments in marketing literature.  But when you step into the land of a specialist or an emergency they often shift to coinsurance payments and/or very large copayments (such as for ambulance services).  They can also change cost sharing from year to year so each year ask for the cost sharing terms. The government caps Medicare Advantage policy holder out of pocket costs to about $5000/year (which is the cap in my K plan).



Friday, April 24, 2015

IBM Medicare OneExchange - A Medicare Tutorial by Kaiser Foundation

The Kaiser Foundation is a great resource for information about Medicare.  The foundation regularly issues reports and statements about Medicare ranging from its history, how it works, who uses it and how much it costs.  They also regularly issue position papers to Congress to try to guide legislators to make informed decisions about Medicare.
    
For example, legislators have embedded in a recent law, H.R. 2 aka the "Doc Fix" law, a provision to eliminate Medicare Supplemental plans that are "first dollar payer" plans.  Congressional representatives decided people who have such plans "go to the doctor more" and thereby cost Medicare more money.  While it is probably true a small percentage of people who have such plans go to the doctor more, the root cause is likely because they are sicker.  Maybe that's why they buy those plans which are substantially more expensive.  But no one in Congress is doing root cause analysis nor reading position papers to find out if their hypothesis is correct.  Our legislators just decided those plans cater to people who are hypochondriacs.  There probably are some.  But the notion that people buy "first dollar pay" plans to be able to frivolously use doctor services is not true.  Who wants to go to the doctor?  As a sample of one, I sure don't.  Kaiser Foundation did advise Congress it was not true.  Congress chose to ignore them.  Amazing.
   
Anyway, the following report, issued in March 2015, by Kaiser is very comprehensive.  It covers the history of Medicare, an analysis of the users of Medicare and the impact of the Affordable Care Act.  It is a long report but I urge you to read it and become educated about Medicare because there is so much misinformation in the media.  This report will help you separate fact from fiction and maybe even be inspired to push your Congressional representatives to act on real information instead of hypothesis:
    
http://kff.org/medicare/report/a-primer-on-medicare-key-facts-about-the-medicare-program-and-the-people-it-covers/
 
I also urge you to pay close attention to what legislators do to Medicare because the changes are subtle and buried in bills like H.R. 2.  Remember, if a representative stays in office for five years they get federal health insurance coverage for life and don't use Medicare.  They have no vested interest in keeping Medicare robust. My hypothesis is majority legislators are taking a back door approach to privatizing Medicare. This "first dollar pay" legislative change did not apply to Medicare Advantage plans.  If it is bad then it should be bad for any insurance plan.  Why not restrict Medicare Advantage plans from doing it?   Do they want to push people to Medicare Advantage plans?  As more people use Medicare Advantage plans, the original Medicare insurance pool will shrink until it becomes unaffordable for the federal government to maintain as an option.  Is there is a slow drum beat to reduce Medicare insurance coverage by pushing seniors into private "managed care" insurance coverage? 





Sunday, April 12, 2015

IBM Medicare OneExchange - Medicare information resources

Medicare is complicated.  Medicare is constantly changing.  Changes are usually small but can have a big impact.  Some changes are great such as the gradual closing of the doughnut hole because of the Affordable Care Act (aka Obamacare).  Some changes aren't really changes, they are just sudden enforcements of existing law. Nonetheless, these changes are confounding.  One example is the current Medicare push to enforce drug denials for "off label" drug usage. There are no easy ways to find out about policy changes.  AARP sometimes will highlight a change in their publications.  But, typically Medicare recipients don't find out about them until they encounter the situation.
    
I volunteer on a help line at a non-profit organization called the Medicare Rights Center (http://www.medicarerights.org/).  Recently, there have been a number of calls regarding the "off label" denial issue.  My normal inclination is to suspect the insurance companies.  However, in this case it is the Medicare administrative arm - CMS that issued instructions to insurance companies to do the denials.  When part D legislation was passed into law in 2003, the insurance rules for drug coverage stipulated drugs are covered only for FDA approved conditions. The reason Medicare cares about what is covered is because Medicare subsidizes the insurance companies.  For example, there is a pain alleviation drug called Lidocaine and it comes in patch form.  It was approved in 1999 by the FDA to treat pain associated with shingles. However, doctors often prescribe it to help with muscle pain.  That's an off label use.  A woman called who had been using the patch for five years for back pain.  Suddenly, her part D plan denied coverage.
   
There was no explanation in the denial notice about why this drug was suddenly denied beyond "not medically necessary".  There is also no point in appealing the denial (unless the off label use is related to a cancer treatment - then Medicare is more flexible) since it is Medicare enforcing the off label restrictions - not the insurance companies.  If you want more information about off label drug use rules in Medicare here is a link:
  
https://drive.google.com/file/d/0B83wVKnNLtjtYjZPZmo1OUpTUGs/view?usp=sharing
  
 Unfortunately, doctors are as clueless as patients about an enforcement until they encounter it.  Sometimes there are workarounds.  For example, if you use a doctor that does not accept Medicare and that doctor orders a lab test at a lab that will accept Medicare,  the test will not be covered by your Medicare insurance because the origin was from a non-participating doctor.  The enforcement of this rule started a couple of years ago.  Non-participating doctors now work with doctors who do accept Medicare to ask them to submit lab tests so that it will be covered.  It's crazy to me to force people to only go to Medicare doctors for everything but that's how the law was designed. 
  
The Medicare Rights Center has a great information data base you can search at     http://www.medicareinteractive.org/  but it is unlikely you will find this type of information.  I suggest when you encounter a baffling denial, call the Medicare Rights Center (1-800-333-4114) because they will know what is trending.  They also have a great subscription (free) newsletter that often highlights these trends.

Of course, you can also always call 1-800-MEDICARE to ask questions.  Did you know --- the Medicare helpline is available 24 hours a day, 7 days a week? The best time to call is late at night or early in the morning.  I suggest you use the rule of 3 when you call Medicare.  What is the rule of 3?  Call 3 different times to ask the same question.  Medicare call center agents highly vary in capability.  It's not as bad as OneX.  I am not sure that's a compliment.
   
Finally, if you think the Medicare "rule" is unfair, complain to your congressional representative.  Tell them, if the rule is so great, why aren't they required to use Medicare when they retire from congress. Retired congressional representatives get federal health insurance coverage for life if they have been in congress at least five years.  That's actually less then the eligibility for Medicare, which requires 10 years of work.   Also, support AARP.  It is a powerful resource as a Medicare lobby organization.

Wednesday, April 8, 2015

IBM One Exchange Medicare Insurance Denial Appeals & Provider Bills

When your Medicare medical insurance denies to pay for a service already provided by a medical practitioner, by law, you have the right to appeal the denial. Unfortunately, One Exchange aka Towers Watson will not help you as they have no legal requirement to help you resolve the situation nor have they contracted with IBM to provide such services.  As I have written so many times before, they are just insurance agents. You are on your own.  Any complaint you decide to pursue must be done via the the standard Medicare appeals process.  It is a legally defined process and  the process steps depend on whether you are using original Medicare or a Medicare Advantage plan.
 
It's almost always worth it to appeal an insurance denial.  There are some obvious "not worth it" situations such as using a doctor who does not take Medicare or having a doctor preform a procedure not covered by Medicare (such as Lasik cataract surgery) and you signed an ABN (advance beneficiary notice) telling you Medicare might not cover it.  However, the denial is more often associated clerical mistakes like a provider coding a procedure incorrectly.  There are always instructions in the insurance denial letter on how to do an appeal.  The instructions are reasonably good.  Also, don't give up if you are denied a second time.  Appeal again!  The reversal rate is something like 50% for people who are persistent about appeals. 
 
I learned something today that is important to know if you decide to do an appeal.  Your provider cannot hound you for full payment of a procedure until all the levels of the insurance appeal are complete.  That can be a lengthy process.  As soon as you decide to appeal, call the provider billing department and follow up with a written letter telling them you are appealing the denial and not to bill you.  They, then, (by Medicare law) can only badger you for the copay or coinsurance for the procedure until you complete the appeals process.  If they threaten to send your full bill to collections, tell them it is illegal and you will file a complaint with Medicare if they do it.

 
 

    
   

Monday, March 23, 2015

IBM Medicare "About Your Benefits" Reference Book

A while ago I mentioned a reference book that IBM sent out in the beginning of 2014.  It is called
"About Your Benefits: Post-Employment" and has a subtitle "Summary Plan Description".
 
A great deal of this book is about plan information for retirees who are under 65.  When IBM stopped providing group insurance to retirees who are Medicare eligible most of the plan description was no longer relevant. 
 
However, there is important information in this book that is easy to overlook.  There are descriptions of programs that are still available to people over 65:
 
  • Life Planning Account which describes the benefits for people who retired by 12/31/2003
  • Special Health Assistance Provision (SHAP) for people who retired pre-1997
  • IBM Adoption Assistance Program 
  • IBM Legal information (which describes your rights to appeal claims that you cannot resolve through Towers Watson)
 
Maybe you did the same thing I did when I first got this book. I tossed it aside and assumed it no longer applied to me.  I subsequently had some trouble with a Life Planning issue and decided to look into the details of the plan by going to netbenefits.com.  I ended up finding my answers in this book.   
 
Here is a link to the letter we got with the book and the front cover of the book.  https://drive.google.com/file/d/0B83wVKnNLtjtYmJJaHktdTdPWUU/view?usp=sharing .You can find the book in netbenefits.com but it's a whole lot easier to peruse the hardcopy version.  If you cannot find your copy ... I suggest you call the IBM Employee Center and get a new one.        

Thursday, March 5, 2015

IBM Medicare Supplement Provider Refund Aggravation

We just received a refund check from the hospital for a claim I paid before my spouse's Medicare Supplemental plan agreed to pay it.  In a previous post, I said I'd do a happy dance when I got the check.  Well, it's a short lived happy dance.  Nonetheless, it is a victory.  Seems the complaint letter to the CEO of the hospital did inspire the billing department to get into action and correct the situation.
   
I thought I was on the path to a full blown resolution of the refund situation and the hospital check would be the final fix.  Unfortunately, a couple of days ago, that changed. We got a bill from my spouse's primary care provider group and there was no refund showing any where on the bill applied to the balance due (that was how they were going to refund our money).  In fact, their bill could not have been more of a mess.  I get the feeling the provider group change accounting systems in the beginning of 2015. 
       
This new bill showed a new account number and my spouse's name included a middle initial (something they had not done before).  In addition, the bill had a line item for a doctor visit in December 2014 which was not submitted to the 2014 cheapo Medicare Supplemental plan for payment.
 
I tried calling the group billing department at least five times but could not get an answer.  I decided to skip trying email and sent a letter with copies of an old bill, the new bill and information about the claim refund that is due.  I also told them to submit the December claim to the cheapo insurance. 
     
I have an hypothesis about all the machinations we've gone through to get our situation resolved.  It seems no matter what the organization: insurance companies, hospitals, doctor groups, governmental complaint agencies, corporations (ergo, Towers Watson) ... all these organizations are operationally incompetent and/or somehow short changing the customer.  My hypothesis is the layoffs, reorganizations, consolidations, outsourcing and the organizational push to be ever more efficient have produced enormous dysfunction. "Do more with less" ends up being "Do less with less and if  the customer gets shabby service so be it".  Where are the Watsons when we need them?

Update on 4/19/15:  Time to do an unreserved happy dance.  The last provider finally sent a refund check.  Wow.  It only took about 6 months to resolve this mess.  Amazing.


   

Thursday, February 19, 2015

IBM OneExchange Claims Processing Issues (and why I use FAX)

I know, I know --- how geriatric am I --- I use a fax machine to submit my claims.  How antique.  I also do not do recurring/automatic payments.  I am faxing claim submissions for several reasons.
    
I can quickly and easily talk through claims processing errors with OneX while making notes on the submission claim form so that there is a clear record of my interactions.  I skip the snail mail cost of stamps and printer ink to make copies of claims and documentation by faxing. Mostly, I believe it will be a lot easier for my family to know exactly what claims I have submitted and read about all my conversations with OneX by just looking at my hardcopy claims folder if I am unable to do it.  My spouse is totally cantankerous about this IBM transition (read that as ornery), resents the HRA funding process and would abandon the reimbursement rather than dig around my computer to figure out the process. I've warned the kids about it but when I try to show the process to them their eyes glaze over. My feeling is maybe my hardcopy folder will help them quickly understand the process and history. However, I have reconsidered my position on recurring payments and decided I should enroll in those payments just because of that last reason. It would mean that at least the insurance premiums would be automatically reimbursed if I am unable to submit claims and no one else takes the time to file claims.  Anyway,  OneX also made a lot of mistakes last year.  Unfortunately, the mistakes continue.
         
In January, a processor rejected one of my claims saying there was inadequate documentation.  I called OneX and the call center rep went through the fax image of the claim.  She  said the processor clearly made a mistake and she'd send it in for review.  I never heard about that claim again. Two days ago, two of my claims were rejected for the same reason.  The call center rep I spoke to yesterday said the fax pages must have not transmitted.  When I asked if he went through the fax image to see if they had transmitted, he admitted he did not.  But, it didn't matter, he said, since the only way to get all three claims reconsidered was to resend them to OneX.   Sigh.
     
It's not a big deal to resubmit the claims, just annoying.  They are premium payments so I am going to do the recurring/automatic payment process for all our premium payments to try to curb the processing errors as well as deal with my recalcitrant spouse. 
 
Update:

Well, I, once again, am an idiot.  No matter how many times the call center representatives give me incorrect information I continue to believe them.  I called OneX to activate Automatic Reimbursement for the policies we bought through OneX thinking she could just "do it" and I wouldn't have to troll around the website.  The call center rep told me I had to submit a recurring reimbursement form.  I asked if I could do it online but she told me I needed to send in the form. She said she could just mail me the form or I could get the form online but I had to send in the form. She never asked nor did I say we bought the policies through OneX. I assumed (there I go again being an optimist) she could see it in our account. I had some forms they sent out last year so I didn't need to go online. After I faxed the form I decided to read the back of it and the form doesn't apply for policies we bought through OneX. Then, I decided I should just go online and see how to activate it.  It is embarrassingly simple.  Duh. 

Saturday, February 14, 2015

IBM Medicare Supplement Provider Refund Problems

My happy dance over getting the 2014 cheapo supplement insurance plan to properly pay claims didn't last long.  Since the middle of December I have been trying to get the providers (doctors and hospitals) that have been overpaid to refund our money. 
    
The Medicare supplemental (aka medigap) insurer sent us a letter stating they only provided claim payments to providers and not to beneficiaries.  We had paid all the claims to these providers, who were very prompt about requesting payment, by the end of September.  So, when they received payment from the insurance company they were obviously overpaid.  I waited a couple of weeks after being notified the insurance company sent them payments before calling providers to see if they got the money and issued refund checks.  I am such an optimist.  By early January, I received no refunds so I started calling providers that had been overpaid.  It was an easy call for doctors who were part of a group practice.  The accounting office readily agreed they were overpaid and said they would refund the money.  I am mildly irritated that I needed to call at all, but at least they acknowledged the overpayment.
   
Dealing with the hospital and the hospital doctors was not as easy by a long stretch.  I struggled through calls to different accounting departments - which I had to do based on what service was provided.  I was told there were multiple accounts and needed to talk through each procedure's payment for the customer representative to tell me whether or not it was overpaid.  In one case, the customer representative said they had sent a payment back to the insurance company because it had been overpaid.  In another case the customer rep said a claim had never been submitted to the insurance company but that she would do it. Unbelievable, right?  
  
One customer service rep finally did agree a refund was due and said it would be sent. It was less than what I believed it should be but at this stage any refund is a good refund.  Anyway, nothing was repaid to us.  In mid January I wrote to the different accounting departments in the hospital (no joke) and provided evidence of overpayment to try to get a refund.  Still, we received nothing.  This week (mid February) I wrote to the hospital CEO to complain about the situation. 
 
I also went on the hunt for a governmental agency that might help.  It turns out the Department of Health only takes complaints about providers who are medically negligent.  They clearly state, don't complain to us if you have a billing problem. Medicare won't take the complaint.  CMS (the agency handling Medicare operations) clearly states they only handle provider fraud complaints. Fraud is when a doctor bills Medicare for a procedure that was never administered. This isn't fraud. The only agency I found where I can complain is the state Attorney General Consumer Protection Bureau.  I am hoping I don't have to do it as it will likely take months, if not years, for the Consumer Protection Bureau to even read my submission much less act on it.    All governmental protection agencies have had significant personnel reductions.   It's no wonder organizations are casual about their consumer interactions.  The complaint process is also onerous as I have to supply all the supporting documentation as well as file the complaint.  I sure hope the CEO letter provides some magic.
 
So, I once again urge you all to be diligent about analyzing your insurance statements, making sure doctors have submitted claims properly and making sure you track your deductibles before making provider payments. 

Update:  The CEO complaint letter seems to have been the catalyst to finally get the hospital to refund money.  I just got off the phone with the billing supervisor who agreed that we are due a refund but not without some taffy pulling.  At first she insisted there was no refund due.  I had all the information about the claims, dates and payments and started listing them off.  She then looked more closely at all the claims and agreed the hospital had been overpaid.  She said, "I was just looking at the payments for May".  It's beyond me why she was not looking at ALL the payments!  Although I feel it might finally be resolved,  I will refrain from doing a happy dance until I get the check.

Monday, December 15, 2014

IBM Medicare supplemental medigap VICTORY

Holy cow ... sometimes being unwilling to "let it go" pays off!
   
I got the mail tonight and the cheapo medigap insurance company capitulated!!!  They paid the claims they were supposed to pay.  Unfortunately, they paid the providers (who had already been paid) so we'll have to wait for the providers to refund us the money.  BUT ... they paid!!!  And it was more than I thought it was ... about $1,500. 
 
I think the magic words I used in my last letter to them was that what they were doing was Medicare fraud and I would be filing agency complaints.  What a pity that it took such words to push them into action. 
 
Meanwhile, there are others out there that are being cheated and they don't even know it.  I sure hope the agencies I complained to will not treat this as a "closed case" and still investigate this company.
 
I also hope I have helped someone who is reading this blog to learn how to deal with insurance companies.  Keep reading the statements they send to you.  You have to work at understanding the statements and if it doesn't add up ... challenge the company.  Use the threat of involving state and federal agencies to support your case.
     
Clearly, if I had been wrong about their processing of the claims they wouldn't have paid them.  
Here's the crazy part ...  no explanation, no apology ... just a bunch of processing forms arrived that showed they paid a bunch of doctors money.  How guilty is that? 
     
Beware ... insurance companies are ruthless.
 
Update:  The cheapo insurance company sent a letter on December 24, 2014 explaining what happened.  They said they made a "clerical error".   They said they provided a more detailed explanation to the NYS Department of Insurance and have recalculated the deductible. Those rascally clerical errors and incompetent clerks just cannot be trusted.