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 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 or anyplace else will tell you these things because it would make insurance companies very unhappy and most advisers 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 might take months for them to get money out of this insurance company even when they do it right. Make sure when you get a bill from your doctor or hospital that they have sent the claim to your medigap.  It will show it as a line item on the bill even if they get $0 from the medigap.  If you don't see the line item call the provider and ask them to file a claim with the medigap. 
  • 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.
  • Update 3/17/15: Ask for a sample EOB statement:  We just received an EOB (Explanation of Benefits)  statement from the new Medicare Supplemental plan.  It is one of the easiest to read statements I have ever seen.  It's better than the Aetna EOB Integration statements we used to get.  If you are considering changing to a new Medicare Supplemental insurance company, ask them to give you a sample EOB statement before you make the change. The quality of the statement says a lot about the caliber of the company.
  • 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.


  1. I read that, when changing a medigap policy company, you have to fill out a "replacement form", agreeing to drop all other individual medigap policies. On my state's(NC) SHIP website, it states that, by signing this form, you are indicating that you understand the risks of changing policies. My question is "what are the risks of changing policies" that they are talking about? If I am keeping a HD F, just changing companies, and the new company has "crossover" and a good reputation, are there other "risks" in doing so? Also, where did you search to find "reviews" by consumers of the companies you were considering. My company has "excellent" financial ratings, but I would like to see consumer ratings from people that actually had claims for them to pay. At today's rates, my company is the cheapest in NC for a HD F until the age of 81. At that point, if I am still around, I would be looking into changing companies. Thanks for any info you can give me.

    1. I recommend you call the NC SHIP (phone number can be found at to find out the exact rules. Even though you are changing to the same policy - the fact that you are going to a different insurance company might mean that you will have a 6 month waiting period on pre-existing conditions and/or they can do other underwriting. Unfortunately, each state has it's own rules. Also, the SHIP can tell you where the NC Department of Insurance has consumer ratings. It's not always easy to find those ratings. You should be able to get through to the SHIP now that fall enrollment is over. Hope that helps.