Monday, December 15, 2014

IBM Medicare supplemental 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.

Sunday, December 14, 2014

IBM Medicare OneExchange Medicare Supplemental story continues

It's been a couple of weeks since I wrote about my medigap hijacking story and I am sorry to say nothing has improved.  The company refuses to acknowledge my spouse hit the medigap F deductible and therefore should be paying the coinsurance claims. They sent a bunch of crap information back that basically was smoke and mirrors. It amazes me how they just stonewall the complaint no matter how much information I provide to prove the case. 
 
I am also amazed how long it is taking for State's Department of Insurance to respond to my complaint.  I filed the complaint in the middle of November and when I look on their website they still have not assigned it to an investigator.  That says a lot about the state services provided.  They must have two investigators to support millions of consumers.
 
Last week I found another state insurance department - a fraud department.  It wasn't obvious that it existed.  I Google searched to find it.  I sent in a request for a fraud investigation of the insurance company. Who knows if that will result in any action.  Even if it does result in an investigation, it doesn't mean we'll get money back from the insurance company.
   
I suspect this is how this insurance company makes money on medigap F high deductible plans.  They tell policy holders they haven't hit the deductible until there is way more coinsurance paid than the actual deductible amount and it's highly likely the policy holder will never notice it.  If the policy holder does notice but doesn't pay the providers the providers will send bills to collections so we had no choice but to pay the providers.  The goat rodeo that follows to try to get the insurance company to back pay to the actual deductible is impossible.  There is no intervening agency that will force them to pay or lose their license to sell policies.  All I can do at this point is take them to small claims court.  Even then, they can stonewall the payout.  Most small claims court awards never get paid. 
 
I will also try to get the Medicare federal inspector general to investigate the company.  However, I am pessimistic that the agency will even read my complaint much less do anything about it.  There have been many cutbacks at the state and federal level to agencies that support advocacy for consumers because lobbyists keep demanding more "cuts to bureaucracy". 
 
Once again, I lament what IBM did by throwing us into this den of insurance provider wolves.  Losing IBM's power to advocate and get insurance companies to behave is a huge loss for us.  Just a huge loss.

Thursday, November 13, 2014

IBM Medicare OneExchange Medicare Supplemental Plan (medigap) experience

I've written a lot about Medicare Supplemental insurance and I thought I knew a lot about this insurance.  However, I have discovered I still have a whole lot to learn.  Oh, I know about the structure of the plans, how they are defined by law, and how an "N" plan is an "N" plan no matter who sells it and to "do the math".  I learned all about that stuff on medicare.gov and a myriad of other websites that describe types of medigaps.  However, none of those sites ever said a thing about the caliber of the insurance provider.  That's where my knowledge was (and is) woefully lacking.
 
It is true that the Medicare Supplemental policies are all the same.  However the insurance company services are certainly not the same. No one from medicare.oneexchange.com/ibm or anyplace else will tell you these things because it would make insurance companies very unhappy and most advisors have relationships with those companies:

  • Buying a policy:  The standard advice about buying a medigap policy is to buy the cheapest one sold for the letter category you have selected.  So, I went to the department of insurance website for my state to find the list of who sells what type of medigap and at what price.  I was so excited when I saw the cheapest premium for the medigap plan I wanted was almost 50% less than the next higher price insurance company.  I tried everything but stand on my head to get that "cheapest" company to respond to my request to buy a policy.  I called them.  I emailed them.  I complained to the department of insurance that they were unresponsive and I said I suspected they only sold the policy if you bought other policies from them (which is illegal).  Nothing worked. There was no buying that cheapest policy.  So, I went to the second "cheapest" insurance company to buy the policy. I'll call them cheapo. They insisted the only way I could buy their policy was by having one of their insurance agents VISIT MY HOUSE.  So, I endured multiple visits from their agent and a dreary sales pitch about all the products they offered.  I begged her to stop, telling her all I wanted was a medigap.  She felt bad but she pressed on.  I finally was able to buy the policy. A couple of months later they fired her.  I guess she wasn't pushy enough. 

          
  • Paying premiums for a policy:  I hate, hate, hate for any company to automatically take premiums out of my bank account.  It has been my experience that it is a nightmare to get them to stop and then forever to recoup any premiums they take after the policy is canceled. However, this "second cheapest" aka cheapo company insisted it is how they keep their costs down.  So, I relented and let them do it.  I must say, they never miss a beat when it comes to collecting the premium.  I cringe over how hard it is going to be to get them to stop when I cancel the policy at the end of this year.
        
  • Paying the doctors (the medical providers):  In order for this cheapo insurance company to get a claim the doctors and the hospitals have to be very precise about how they file the claim with Medicare.  If they do not put exactly the right information about this medigap in the claim then it will not be sent by Medicare to the medigap via MAIL.  That's because this cheapo company will not implement automatic electronic crossover.  I never thought to ask them about that when I bought the policy.  I thought everyone did crossover.  So, one provider screwed up and didn't put the right information into their claims.  I didn't realize it because I don't get benefit from the plan until I meet a deductible.  Fixing that has turned out to be highly irritating and the provider is mad at me because they did it wrong! Even when it is done right, it seemed odd to me that it sometimes takes at least two months before I get bills from a doctor.  It turns out even when the doctor properly processes the claim, they cannot bill me until the cheapo company processes the claim and tells them I haven't yet met the deductible.   That's the law. They are not exactly speedy in their processing.  It's no wonder some doctors tell people with medigap insurance they want to be paid "up front" because it will take months for them to get money out of this insurance company.
     
  • Tracking out-of-pocket costs for a deductible policy:  I am miserable about this issue and freaking out that I never thought about it as an issue.  One would think the cheapo insurance company would do this and automatically make coinsurance payments to doctors when I hit the deductible.  One would think.  Wait, it gets better.  How about, one would think the running total the cheapo company puts on the EOB tallying the YTD deductible is accurate.  One thinking that would be very wrong. I got at least 15 statements from the cheapo company.  But I never added up the expense amount across those 15 claims.  I just kept looking at the YTD total.  I am a total idiot to not have done the math myself until this week.  I'm about $900 over having met the deductible.  All I could say is HOLY $#@# and hold my head in my hands for being so stupid. It's going to take forever to get them to pay me that money back.  I just know it.
     
  • Providing customer service:  Want to guess the caliber of customer service provided by the cheapo company to try to resolve this problem?  I just loved arguing with the call center representative who insisted I was wrong until I went through several claims with her.  Then she said ... we'll check into this and get back to you.  Fat chance they will do that with just a phone call.  I knew I would have to start a letter writing campaign.
     
  • Seeking resolution of a problem:  I don't know how long this is going to take but I don't have a good feeling.  I already sent in a written complaint to their claims department and their home office.  I also complained to the department of insurance (again) but this time I might get their attention because this is "fraud". It took me several days to compile the information and try to accurately describe the situation.  I'm sure I aged a couple of years trying to do it. 
      
So, I am war worn from this experience and will switch to a different medigap insurance provider in 2015.  When I started looking at the third cheapest company that sells the policy type I currently have, I went online to look at consumer complaints.  It wasn't pretty. I'm not going anywhere near that mess as it sounds worse than what I just described.  So, I am switching to a "K" plan only because I can buy it from a reputable insurance provider.  I'm not thrilled to buy "K" but it's the best option I can find for a "deductible" plan that is sold by a reputable insurance company.  I hope someone else can learn from my saga.  No one should have to deal with a disreputable insurance company but it's crueler still for old people to have to beat their way through this swamp.

Wednesday, November 5, 2014

IBM medicare.oneexchange.com/ibm Website and Conversation

I finally called OneExchange a few days ago to confirm part D insurance enrollment and to ask to be dis-enrolled in a vision plan that we had selected through OneExchange. They never fail to disappoint. 
 
First, the OneExchange website is still a mess. I looked at the plans available in my zip code and they still do not display the AARP UHC plans on the website - to find out that information  you must call OneExchange.  Then, I checked our enrollment information to verify our plans. The information for my part D plan is correct.  However, for my spouse, the information showed he was enrolled in TWO part D plans.  Now, that's not possible (by law, Medicare will not allow it) but it was not clear what they were trying to describe.  Last year there was a problem with the first part D plan, so my spouse had to switch to a different plan.  The website displays both plans but does not have any indication of which plan is active.  There was also no way to use the OneExchange website to dis-enroll from the vision plan. 
 
Next, I called OneExchange.  Similar to my experience last year, I was placed on hold for about 25 minutes before I spoke to a client representative.  I asked to representative (who was very nice) to confirm our part D enrollments and to explain why two part D plans were showing on the website for my spouse.  She put me on hold for about 10 minutes two times to try to get a logical answer for the two part D plans issue.  She finally said she was told it is because the website is showing enrollment history.  Ergo, there is no logical answer.  She did confirm our enrollments for our respective part D plans.
 
I then asked her to dis-enroll us from the vision plans for 2015 as we no longer wanted them.  She promptly said OneExchange cannot do it and I must call the insurance carrier to dis-enroll.  Now, that's also not logical.  An insurance agent (which OneExchange certainly is) can most certainly handle a dis-enrollment for these kinds of plans.  It's just not a service they provide. 
 
Although it is rather hateful to do it, I continue to encourage everyone to make sure to call OneExchange before December 7 and confirm all 2015 plan enrollments.  Make sure to record the date, time and agent name when you call just in case you need to do a Medicare appeal in 2015.  I also went to www.medicare.gov and verified our  respective  part D enrollments.  OneExchange is still too clumsy to trust.
 
 

Saturday, October 18, 2014

IBM OneExchange HRA/FHA 2015 Disbursements

A recent mailing from OneExchange about Medicare part B premium recurring reimbursements couldn't have been more confusing in both the content and the timing.  There is no explaining why they chose to send out that mailing now.  It seems to me they could have done it months ago. People are confused enough right now about whether or not they need to do anything for enrollment.
  
Here's the deal on HRA reimbursements.  You can get reimbursements two ways.  It can be recurring or you can file for them yourself.  You can get reimbursed for bills such as your insurance premiums, your copays (aka coinsurance), doctor bills for doctors that do not take Medicare.  Medicare part B premiums are just "insurance premiums".
 
In an earlier post I mentioned that people who could afford to "pre-pay" insurance policy premiums for an entire year and then submit the claim to OneExchange to be reimbursed were able to very quickly "drain" their HRA accounts and were done with any reimbursement paperwork by February. However, you cannot do that with Medicare part B premiums.  The federal government is not setup for "prepay"!
  
Reminder for those people who retired before 1997 and get SHAP reimbursement for part B premiums up to a maximum of $900 - you can only apply for reimbursement from OneExchange for the remaining amount of part B payments you make ($358.80 if your part B is $104.90 in 2014).
 
  

IBM OneExchange Medicare 2015 Enrollment Directions

The emails and USPS mailings from IBM and OneExchange over the last week that couldn't be more confusing.  It's easy enough for me to confuse myself - I really don't need any more help.
 
There is an implication that we must "do something" to keep getting the IBM HRA/FHA.  If you already enrolled in a medical or prescription drug plan through OneExchange aka ExtendHealth  in the last 12 months then you don't need to "re-enroll" in the plan if it is still an active plan.
 
Here's when you need to "do something" regarding OneExchange enrollment: 
  • The Medicare Advantage or prescription drug plan you use will not be offered in 2015.  Then you need to find a new medical or prescription drug plan.
  • Your Medicare Advantage or prescription drug plan (PDP) will change in 2015 and you don't like the changes.  For example, the premium is increasing, the formulary is changing or the Medicare Advantage plan is changing their doctor network and excluding your doctor.
Although you don't need to contact OneExchange and do anything - I suggest you call them to verify you don't need to do anything.  Make notes on when and who you talked with and what they said.  That is just a little preventative medicine in case you need to file a complaint with Medicare because OneExchange screws up.  Remember ... OneExchange is an insurance agent to Medicare.  As such, if you find they have screwed up your enrollment and put you in a wrong plan or dis-enrolled you can appeal to Medicare that you were misled by an insurance agent and get it fixed.  But you need names and dates to make a good case for it.   If OneX screws up and denies access to your HRA you need that information to file an appeal with the IBM Plan Administrator that you were misinformed. 
   
I also want to keep reminding you that Medigaps aka Medicare Supplemental insurance policies for participants who use Original Medicare are not part of the Medicare Fall Enrollment process.  There are very specific rules for when/if you can enroll/dis-enroll in Medigaps.  You MUST look at your state rules for those policies. DO NOT make any changes until you know the full consequences of those changes.

Sorry to say - you have to have an advocate to be sure this stuff is done correctly.  I keep trying to educate my children on Medicare and my IBM HRA just in case I can't be my own advocate as I get older. They mostly ignore me but I know some of it is sinking in.

Sunday, September 14, 2014

IBM OneExchange Medicare Supplement F High Deductible Experience

I'll start with a lament.  I still hugely miss IBM's retiree group plan for Medicare secondary insurance provided through Aetna Integration plan.  It offered such great coverage that went beyond what is provided by the government sanctioned Medicare supplemental plans and was so easy to use. It was a big, big take away.  End of lament.
     
I've written in early posts how I opted to stay with "Original Medicare" because I wanted maximum flexibility to be able to go to any doctor or clinic who would take Medicare anywhere in the country ( http://ibmmedicare.blogspot.com/2013/09/ibm-extend-health-why-i-like-original.html).  Another small reason I chose original Medicare is political.  Our federal government is using additional tax payer dollars to subsidize enrollees in Medicare Advantage plans versus enrollees in original Medicare.  Ergo, the government is subsidizing private insurance companies - another example of corporate welfare. The Affordable Care Act is trying to eliminate those extra payments but there is a slow phase out. 
   
Anyway, original Medicare is good insurance but medical copayments and deductible payments are limitless and can become exorbitant for catastrophic diseases.  Supplemental (aka medigap) insurance policies (offered by private insurance companies) provide insurance coverage for the copayments (known as coinsurance) and deductibles and thereby cap out of pocket costs. However, they offer no additional medical coverage (e.g., visits to an acupuncturist as was in Aetna Integration) and will only cover deductibles and copays for claims approved by original Medicare.
 
I decided my spouse and I would get  medigap F high deductible (F-HD) plans because the premiums are really low.  These plan do not provide any benefit at all until the client pays $2140 of copays and deductibles in a given year.  If those payments do exceed the $2140 the insurance then kicks in and  pays all deductibles and copays for the rest of the year. The counter resets every January.
    
This has been a complex medical year for my spouse. Even so, the total cost of copays and deductibles still hasn't even come close to $2140 so the medigap F-HD insurance has provided no benefit at all.  HOWEVER, the policy premiums are so low ($87/month - which is low for NY) that we are financially still way ahead by hundreds of dollars compared to buying a higher premium policy (e.g., medigap N) for a different kind of medigap that would have paid copays and deductibles immediately. We'll stay with F-HD plans for 2015.
   
As with any insurance coverage - car, house, boat ... the insurance premium paid goes up the more coverage you want.  Medicare Advantage plans sometimes obscure the fact that you are getting less (e.g., restricted doctor networks) for your premium payment - which might just be your part B premium.  Medigap plan premiums are high if you want copays and deductibles immediately covered.  During this fall enrollment time - I once again urge you to "do the math" and make sure your premium is worth the benefit you are receiving.
 
Updated 9/20/14:  I should have added to this post that you should check from time to time on your state's department of insurance website (in New York https://myportal.dfs.ny.gov/web/guest-applications/medicare-monthly-premiums) or call your state health insurance assistance agency  (www.shiptalk.org lists the phone number) to find out if there are new providers of  Medicare Supplemental plan offerings or if there have been premium changes for existing providers.  The state health insurance agency (aka SHIP) will also know the state rules for when or if you can switch to a different medigap plan.

Tuesday, September 2, 2014

IBM Medicare OneExchange 2014 fall open enrollment

For those of us already enrolled in Medicare, October 15 - December 7, 2014 is the annual open enrollment period.  This, by law, is the federal government's time of year when it allows Medicare recipients to make changes for Medicare Advantage plans and Medicare prescription drug plans to be effective for 2015.  It is NOT an official enrollment time to make changes to Medicare supplemental plans (aka medigap plans).  Medigap plans are regulated by state laws and your state determines when and whether you can switch from one medigap plan to another.  For example, in New York state you can change medigap policies any time you want to be effective the beginning of the next month.  It's called continuous enrollment.
 
What does all this have to do with OneExchange?  You are required to purchase at least one private insurance policy from OneExchange to get your HRA subsidy.  If you bought a Medicare Advantage plan or a drug plan and you are happy with the plan then you don't need to make any changes for 2015 and don't need to talk to anyone at OneExchange.  HOWEVER, you must RELOOK at your plan to be sure it will continue to provide the benefits you want in 2015 and take action if the plan is no longer meeting your needs.
 
This is the time of year private insurance plans make changes to benefits and to formularies (the list of drugs they will cover) for the plans they offer.  Your current plan should send you a notification of changes by the beginning of October.  I suggest that the best way to find out which prescription drugs your plan will cover is on the Medicare website (www.medicare.gov).  Plan updates will be posted on that website by October 15, 2014. That's when to do the "plan finder". Enter your drugs and look at available plans in your zip code that provide the best coverage.
 
If the medical or drug plan you currently have through OneExchange is no longer suitable, you will need to switch to a better OneExchange plan and you MUST make Medicare Advantage or part D insurance plan changes before December 8th since there is no special enrollment period for IBMers this year. The Medicare dates of Oct. 15 - Dec. 7  apply to make those changes. Again, it does not apply to Medicare Supplemental/medigap policies.  You need to talk to your state first to find out the rules for making those changes before you change anything with OneExchange. Unfortunately, switching means going through the OneExchange enrollment process again.
 

Thursday, June 12, 2014

IBM Medicare HRA Claims for Uninsured Doctor or Dental Bills

I have been trying to get claims processed for two health provider bills that are not covered by my insurance.  It took several months, multiple denials and conversations with four different OneExchange agents before I got the right answer. It turns out there can be absolutely no reference to "insurance" anywhere on the provider bill.
   
In the case of the doctor services, I tried to submit evidence of doctor service and fees by using a uniform insurance form my doctor has always given to me.    He does not "accept" any insurance and requires payment by the client.  However, he does provide a bill on this form with diagnostic codes so the client can submit a claim to insurance for reimbursement (should it be a covered service).  Since he accepts no insurance - he obviously has opted out of Medicare. Because I provided that form to OneExchange as evidence of my doctor bill they immediately denied the claim. The claim denial said they wanted to see a copy of the insurance denial. They wanted a "pure" doctor bill on the doctor's stationary to remove that requirement.
    
I found this out because I recently submitted a bill from my dentist.  The dentist forgot I no longer had insurance and sent the claim to MetLife.  Of course, it was denied.  Then the dentist sent me a bill showing a claim had been sent to MetLife and $0 had been paid.  That line item caused OneExchange to deny my dental reimbursement claim because they again wanted to see the dental insurance claim denial.  When I called OneExchange to complain, the agent told me there can be no reference to insurance on the bill.  So, I whited out the line about MetLife and resubmitted the dentist statement.  Voila.  The claim was paid.
    
I complained to the agent that there was no way for me to know this "rule".  The agent said it is on the website.  Mea Culpa. I didn't read the entire website before submitting claims.  Of course, the denial reason couldn't explain that the reference to potential insurance coverage is the reason for the denial.  I mean, that is a lot to ask.
 

Wednesday, May 28, 2014

IBM Medicare HRA setup for IBM retiree couples

Yesterday a customer service representative at OneExchange further explained the account setup for married couples who have both retired from IBM.  I have never seen any documentation about why and how they setup those accounts.
  
The account is setup in the name of the person who is oldest.  In my case, that is my spouse.  The HRA subsidy for both people is put into one account.  Because we each have power of attorney for the other we are both able to access the account. 
 
The rep said there is huge benefit to having one account.  The amount of money in the account is available to cover the bills and premiums of either person to whatever amount is in the account.  So, it is possible to spend the entire account on just one person.
 
The rep went on to said if the accounts were separated then each person could only spend their own HRA money limit.  The couple would not have access to each other's money -  meaning if one underspent the HRA benefit the other could not tap into that remaining balance.
 
I have not seen that explanation written anywhere.  All I knew is when the account was setup it was one account in my spouse's name.  One customer service rep told me  I could split it apart when I questioned it earlier this year but did not tell me the ramifications.  I was concerned about what would happen when one of us dies but decided to not do a thing about it until next year. 
 
This customer representative told me they will settle it out when one of us dies and it is no issue. 
 
I haven't yet applied my rule of "ask 3 times" to be more confident that the answers provided are correct.  Maybe later in the summer I will ask again.