Monday, January 27, 2014

IBM Medicare Extend Health - Medicare and medigap (aka supplemental) claims crossover

If you are using Original Medicare and have a secondary medigap supplemental insurance policy the medigap usually will have a crossover agreement with Medicare to get your claims from Medicare. How the crossover agreement works will depend on the secondary insurance company that issued your policy. Automatic crossover claims processing is really easy.  After I set it up,  I never had to file any claims with Aetna.  Medicare automatically sent claims to Aetna.  Do not assume your new medigap insurance company will do the same.
I have a user account on so I can see claims filed by doctors and also see my insurance profile without having to call Medicare or wait for a Medicare Summary Notice (aka MSN) which is mailed out once a quarter.  I looked at my secondary insurance profile on  today and it still showed Aetna as my secondary insurance.  There is no capability for a Medicare recipient to change that field.  Only insurance companies are authorized to notify Medicare of changes and it takes approximately 6 weeks for a change to be implemented.
If you have a medigap policy, your secondary insurance company may be willing to work with both the old IBM plan and Medicare to make the change. Call your insurance company and ask if they will do it or if they have already done it. When I first used Aetna Integration, it took one call to them and they worked with both Medicare and United Heath Care to make the change. 
This time, my insurance company would not do changes because of how they do crossover. It is not automatic.  I am paying a really low premium for a medigap F high deductible insurance plan so  I had low expectations. Also, Aetna did not notify Medicare that my 2013 policy terminated which is sort of crazy because it means Medicare would keep sending claims until Aetna told them to stop.  Aetna would have to keep denying those claims -- all of which has to have some administrative cost. Anyway, I called Aetna to have them notify Medicare my plan terminated.  Then I called my new insurance company to find out how their crossover works. 
By way of example, this is how my company does it - which is not great but worth the low premium:
  • I ask the doctor's office to put the insurance company code on the Medicare claim form (in position 9D).  That code tells Medicare to fax or mail a copy of the claim to the insurance company. If there are Medicare employees involved in the process, I bet it doesn't work very well but it's worth trying.
  • If the doctor's office cannot, I could ask if them to fax or mail a copy of the Medicare insurance claim directly to the insurance company. Since that does require human action, I won't ask.
  • If the doctor's office cannot put the code on the claim,  then I will fax or mail a copy of the MSN to the insurance company when I get it. That is the official copy.  Print out of a claim from the website is not an "official" copy.
Even if there were automatic crossover, an F high deductible plan doesn't start paying until your out-of-pocket is $2110 for Medicare deductibles and copays. I will keep track of my Medicare deductibles and copays because I will submit them to Extend Health for HRA reimbursement. I'll also track it to be sure my insurance company starts paying if I hit the $2110 (and I sure hope that doesn't happen).  Even the IBM medical supplemental insurer United Heath Care was not good about keeping track of my out-of-pocket amounts (it was $4000 last time I used that plan) and made mistakes.

Friday, January 24, 2014

IBM Extend Health Reimbursement Account Rebate Process

The gods do not want me to have an easy time with Extend Heath for either enrollment or for HRA claims.  I just successfully submitted my first claim request to Extend Health after 3 weeks of trying. Don't read that sentence as I will be paid for the claim.  It just means they finally got the claim after several attempts, multiple phone calls and several emails.
In the beginning of January I faxed a claim to Extend Health.  I heard nothing for 3 weeks.  I called them last week and they said they never got my claim.  They blamed my fax machine even though on the same day I sent the fax to EH, I successfully sent a fax to Acclaris.  On Monday I sent another fax.  I called EH on Tuesday to ask if it had arrived and was told Monday was a holiday so they wouldn't have gotten it. After being on hold for 20 minutes they told me they had no fax from me but it would take a day or so to go through faxes they received.  On Wednesday I sent another fax and an email to the IBM support address asking for help.  I was then told by email that it takes up to 5 days to just enter a faxed claim into the system for processing. No one on in the call center told me that - they just led me to believe my faxing capability was not working.  In the meantime, I also found on the claims processing site there is a notifications setting to ask to have an email sent to you when a claim is received.  It is not on the main website for Extend Health where your profile is stored but on the website you are redirected to for the actual claims process.  I also found an email address - I sent an email to that address and it bounced back that the mailbox was full.
Today, I was finally notified my claim has been received because I had set the notification setting to do so.  Yay.
Friends told me to just mail in claims.  That means spending printer ink to make copies and stamps to mail it.  I didn't want to do it online either because I want rock solid evidence of claims I have submitted.
Here is my observation - people who pay the whole year's premium for their insurance up front in January, and send in a paper claim to Extend Health to get their money back are clever devils.  They only have to front the money to pay the entire year of premiums for a few weeks and then they get a check.  In one case, the IBMer and the spouse insurance premium costs for medigaps and part D plans for the year was the entire subsidy and the HRA account was drained in January.  That person has the money and doesn't have to deal with Extend Health again until next year.  How smart!

Saturday, January 18, 2014

IBM Medicare 2014 Remaining Enrollment Options for Extend Health Transition

Hopefully, Medicare eligible IBM retirees already selected and enrolled in replacement medical and part D plans by the end of 2013.  If not, there is still time for some people to do it.  I say "some" because there is a "Special Enrollment Period" (SEP) in 2014 but only for people whose plans were terminated.  For example, if you were using plans that terminated at the end of 2013 such as the IBM medical supplement plan, IBM prescription drug plan, IBM medical supplement and prescription drug plan, or Aetna Integration plan you have until the end of February 2014 to get a replacement plan without any Medicare penalty or preexisting condition underwriting and you will be able to get your IBM HRA subsidy.

There is a Medicare Advantage disenrollment period that Medicare offers at the beginning of every year from January 1 - February 14. During this time Medicare allows people to change from a Medicare Advantage plan to Original Medicare and get a part D plan.  HOWEVER, if you do so, you MIGHT not be able to get an insurance company to sell you a medigap plan if you want one.  This is called guarantee issue rights. State laws regarding medigaps come into play as well other factors. Make sure you determine your eligibility before you drop your Medicare Advantage Plan.  Also, you risk losing access to your IBM subsidy unless you buy a part D or medigap plan offered by Extend Health when you make that change (unless your spouse still has a EH offered plan).
There is an SEP that exists for the entire year that allows you to switch to a 5 star rated plan once during the year.  Again beware - if the 5 star plan is not an EH plan you will lose your subsidy when you make the change.
Medicare law regarding SEPs is complicated and it is easy for Medicare agents, Extend Health agents or non-profits to make mistakes when telling you your rights.  Be sure you ask multiple people, multiple times about your options. Here is a link to a document that describes various SEPs: