Nebraska Department of Insurance
THE NEBRASKA HEALTH INSURANCE INFORMATION, COUNSELING, AND ASSISTANCE (NICA) PROGRAM
SEPTEMBER 2001 NICA NEWS
GOLD RECORDS
Record 5/01 (A. Schroeder): Client quit work in January, so her employer group health insurance plan stopped. She had an MRI in January and they billed the insurance as primary, not Medicare. Claims are being turned over for payment to collection agency. Client had a lot of contact with Medicare regarding the mix up and thought maybe the problem was not corrected. If necessary, client will call Volunteer to help with problem.If an employer has 20 or more employees, the employer plan is always primary. Beneficiaries must notify Social Security when their employer coverage ends. Beneficiaries should ask the employer for documentation showing the end date of the employer health coverage. Also, notify the Medicare carrier in writing that the employer coverage has ended and include employer documentation.
Record 6/01 (J. Catlin): This was a follow-up to last month's report in the Gold Records where the NICA Volunteer looked through a stack of bills. The supplement was not paying because the beneficiary had not canceled with her former HMO in Tulsa, Oklahoma before receiving treatment in Holdrege, NE. NICA Volunteer appealed with the HMO. It is great to report that in June, after appealing and with weekly phone calls from the NICA Volunteer to the HMO, the client received a decision in the mail of the transfer from HMO to Medicare and that the providers would be paid by Medicare. The NICA Volunteer saved this beneficiary over $25,000.
Wow, persistence pays. Thank you for sticking with this, Jill.
Record 5/01 (D. Messersmith): NICA Volunteer visited this couple who have various medical bills. They had previously filed for bankruptcy due to medical expenses. They are making some small payments on their bills. They take various medications, amounting to between $275 to $350 per month. Occasionally, the local clinic gives them samples, but they take five or six prescription drugs.
NICA Volunteer passed along "The Medicine Program" brochure and informed clients of the program. We now have The Medicine Program brochure in Spanish, as well as English.
Record 3/01 (B. Stiles): Client called because he believed his Medicare Supplement was not paying as it should. After looking over his paperwork it appeared that the previous underwriter had a filing agreement with Medicare and the current underwriter did not. In addition, the client had several incorrect ideas about Medicare and Medicare Supplement and what it was supposed to pay.
In the special conditions column of the Rate Comparison Guide, there will be an "AF" (which stands for Automatic File) if the company has signed an agreement with Medicare allowing a beneficiary's Medicare claim to be sent directly to the supplemental insurance company's computer. This agreement eliminates the beneficiary's need to file claims with the supplemental insurance company. The beneficiary should notify the provider of his/her supplement insurance company before services are performed. The beneficiary could also contact the Coordination of Benefits office listed on page 17 of this NICA News.