Medicare Question, supplemental policy

[Pom]

@mrsspunky

FIL Pom had divorced, so we needed to update his supplemental insurance this year.  So Oct 30, we were able to get FIL's application filled out with the help of the county commission on aging and their rep who assists with that recommended a BCBS Medigap C plan.  It was submitted and received at BCBS Nov 6th.  We never got any further information, so we started calling a couple of weeks ago. They kept telling us it was in underwriting. Friday, we finally got someone on the line who researched it further to say that it had remained in uw because his DL was not attached.  She agreed that the reason was faulty because his Driver's License was indeed attached the entire time (we knew that because we have a copy of the submission) and she was to call us back.  I am praying we hear from her tomorrow, but we will be calling anyway.  Is there anything we can do to facilitate this?

So what happens, can they deny him?  We are just shit out of luck if they don't accept him? And now we are pushing up against his old supplement being invalid Dec 31.  This shit gives me a migraine.
 
 

[spunkarella]

I don't have any advice for your situation, but you have my sincere sympathy. I have been dealing with BCBS enrollment from the provider side (at work) for months and what should have been a simple process has proven to be absurdly difficult and convoluted.

What hopefully, finally worked for us on Friday (we'll see) was finding someone with common sense (good luck) and consistently following up with her.

[AAM2012]

I think with any type of insurance application/underwriting review there is always chance it could be denied. However, I don't have your policy paperwork so it could mean that he has a policy/coverage until it's approved or denied as some policies are written that way.

[Deleted]

IME, if an application is NIGO - not in good order aka something is missing - you have 30 days to correct it then it is declined and you have to reapply.

Also you don't want Plan C, so maybe it would be a good thing if it IS declined. You want G or F (not high ded F either).

[Pom]

Dec 22, 2014 0:13:51 GMT -5 @mrsspunky said:

IME, if an application is NIGO - not in good order aka something is missing - you have 30 days to correct it then it is declined and you have to reapply.

Also you don't want Plan C, so maybe it would be a good thing if it IS declined. You want G or F (not high ded F either).

It BCBS Legacy Medigap- maybe it is G.... I will pull out the paperwork and confirm.  We did already receive his RX cards for Wellcare RX plan, so that's one less thing.

Thanks for the reply.

[Deleted]

Dec 22, 2014 7:44:25 GMT -5 Pom said:

Dec 22, 2014 0:13:51 GMT -5 @mrsspunky said:

IME, if an application is NIGO - not in good order aka something is missing - you have 30 days to correct it then it is declined and you have to reapply.

Also you don't want Plan C, so maybe it would be a good thing if it IS declined. You want G or F (not high ded F either).

It BCBS Legacy Medigap- maybe it is G.... I will pull out the paperwork and confirm.  We did already receive his RX cards for Wellcare RX plan, so that's one less thing.

Thanks for the reply.

I did a search for the plan you named and the state in which I think your FIL lives... and apparently one of only 2 plans they offer is Plan C. This is 100x better than the other plan they offer, so good job there! There is a different BCBS plan (My Blue Medigap) that has F.

The problem with C is this - Medicare has 2 types of providers: those that accept Medicare assignment (the usual and customary rate that Medicare pays) as payment and full and those that do not. Those that accept Medicare but not Medicare assignment as payment in full can charge 15% over and above the Medicare contracted rate. Plan C does not cover this 15%, what we call excess charges. Plan F and Plan G do. There is a trend that more doctors are not accepting assignment as PIF so it is on the beneficiary to pay this 15% and there is no OOP max. So a long hospital stay, where you can't choose your doctor, you get whomever does rounds, etc., you may have a provider who doesn't accept assignment and you get a hefty bill... on top of everything else.

[Pom]

Dec 22, 2014 8:22:22 GMT -5 @mrsspunky said:

Dec 22, 2014 7:44:25 GMT -5 Pom said:

It BCBS Legacy Medigap- maybe it is G.... I will pull out the paperwork and confirm.  We did already receive his RX cards for Wellcare RX plan, so that's one less thing.

Thanks for the reply.

I did a search for the plan you named and the state in which I think your FIL lives... and apparently one of only 2 plans they offer is Plan C. This is 100x better than the other plan they offer, so good job there! There is a different BCBS plan (My Blue Medigap) that has F.

The problem with C is this - Medicare has 2 types of providers: those that accept Medicare assignment (the usual and customary rate that Medicare pays) as payment and full and those that do not. Those that accept Medicare but not Medicare assignment as payment in full can charge 15% over and above the Medicare contracted rate. Plan C does not cover this 15%, what we call excess charges. Plan F and Plan G do. There is a trend that more doctors are not accepting assignment as PIF so it is on the beneficiary to pay this 15% and there is no OOP max. So a long hospital stay, where you can't choose your doctor, you get whomever does rounds, etc., you may have a provider who doesn't accept assignment and you get a hefty bill... on top of everything else.

Thank you so much for explaining this!  I was just comparing those and yes it is C.  I appreciate you mentioning this other policy and we will look in to it.  Again, you are so awesome to answer our questions.  Sincere thanks.  It seems so complicated to us newbies.

[Deleted]

When I assisted my parents in getting their supplements, it was denied because they said we didn't submit all the required information. I fought it and won. On both of them- separately. It was a royal PIA but do not give up!!!

[Deleted]

It is complicated, even to people who are ON Medicare, and in whose best interest it is to know such things! You definitely get a pass, and your FIL is really lucky to have you and Mr. Pom to help (albeit begrudgingly on your part )
For instance, MIL and FIL had to change their plans, b/c MIL's old company changed their retiree benefits for 2015. Instead of having a group plan, they eliminated it and basically are giving everyone a stipend to cover their own healthcare. IMO they made a bad decision (went with a company that is brand new and their rates are therefore untested as to how sustainable they are) and are all "but we can change next year, right?" No, no you can not. And when my mom - who will be on Medicare in a matter of months and to whom I've been giving a primer - piped up and gave untrue information, my head nearly exploded.

[Deleted]

Dec 21, 2014 21:56:02 GMT -5 AAM2012 said:

I think with any type of insurance application/underwriting review there is always chance it could be denied. However, I don't have your policy paperwork so it could mean that he has a policy/coverage until it's approved or denied as some policies are written that way.

Every state's rules are slightly different, but in my state and the other states in which I'm licensed, if you are on Medicare and your policy is being terminated for anything that's not your fault (like not paying your premium), you have what's called a guaranteed issue period. This means that underwriting is just a formality - they just check the app for things that are missing or out of place - and the policy gets issued to you without having to answer any health questions or provide evidence of insurability. 

[Ashley&Scott]

My dad has plan F & it's awesome. It picks up everything that Medicare doesn't. He hasn't paid a single medical expense except his monthly premium & prescription copays since he got on the plan 5 years ago. He's had multiple hospital stays & surgeries in that time - it's all been covered 100%.

I hope they are able to process everything quickly. Good luck!

[Deleted]

Dec 22, 2014 13:26:27 GMT -5 operagirl said:

Pom, I hope everything works out with his policy.
@mrsspunky, I'll be 64 in Feb., so I'm interested in this info. Thanks for sharing your knowledge with all of us.  

You can apply for Medicare this time next year - as early as 3 months ahead of when you turn 65. You definitely want to do so as soon as you are able. If you wait until you are already 65, or the end of your open enrollment period, your start date will be delayed.

A good publication for anyone who is interested to look up is the annual Medicare and You handbook. There is a PDF of it online.