Wednesday, April 9, 2014

IBM Medicare and OneExchange - Know Your Rights

Several months ago IBM mailed out a thick manual titled "About Your Benefits: Post-Employment Summary Plan Description". The terms of this document were effective January 1, 2014.  THIS IS AN IMPORTANT DOCUMENT.
Most of what is in that manual is not applicable to IBM Medicare eligible retirees and you may have not bothered to even open the manual. However, there are several sections that are very important to Medicare eligible retirees.  Start from page 165 and try to read all the way through to the end of the manual.
In the Legal Information the manual describes the appeals process if your claims are denied by Towers Watson (page 227).  It's important to know that process because there are timelines associated with appealing denied benefits claims.  Basically, it is a 60 day window from the time of denial for you to appeal.
In the world of Medicare - it is also important to know the appeals process for all your claims handling.  If your insurance denies a claim there are also timeframes within which you must appeal or you can be denied again just based on the fact that you appealed "too late" even though your appeal was improperly denied and you would have succeeded in overturning the ruling had you done it on time.  Timeframes depend on the kind of insurance you have - Original Medicare or Medicare Advantage.
The net of this post is that we now have to know the process of how to appeal when an insurance company denies a claim - Towers Watson does not handle that.  And we also have to know the process of how to appeal when Towers Watson denies a reimbursement. 
Each time a claim is denied by an insurance company they are required to legally tell you the process.  The same does not apply to Towers Watson denying reimbursement claims. Dig out that IBM manual and put it in a place where you can reference it so you know what to do if you have a problem with Towers Watson claims. 

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