Medical bills

[lovebirds]

Hi lovebirds,

Thanks for the nice thoughts and advice. I really appreciate it.

People have been really helpful here.



We're talking to several attorneys today. I'm trying to figure out where we are at and one of the unknowns is will the health insurance company actually go back to 2003 and attempt to collect on it? Sort of hard to find out.

Yes, we're dipping into savings because the cost of the mortgage, insurance, medical bills, etc. is more than the small income we now have. If I get better I can return to work but right now that isn't a possibility.

Best,
Mike

Being jerked around by the medical insurance company is one of my biggest fears. We have quite a bit of medical debt ($50k) while having the best private insurance plan my company offered my husband. And now the hospital will not see my husband for a follow-up because of the insurance denial. They find loopholes for everything.

I'm guessing you could use that money to settle your medical debts but you need it for private insurance and home expenses.

Why does Medicare take 2 years before they offer you health coverage? Most private insurance will not cover pre-existing conditions.

So the medical bills that got rejected (except for 20%) from your insurance company was from 2003? Without any notice? If you were unable to get medicare until January 2010 there has to be a way around this.

Look up bankruptcy exemptions for your state so you know what is protected if you do choose to file.

[LuciluS]

O Mike:

My heart goes out to you and your wife. I received my disablity in August 2006 and was one month away from being eligible for Medicare. My hubby's company had an excellent Medical Insurance Agent who helped me. As I'm sure you know Medicare or Medicaid is not eligible until 6 months after date of disability. He also explained to me, to take the Medicare and also a supplemental policy for better benefits and Precription payment. I was 50 yrs old, then.

He explained to me (and my BIL agreed) you must have Medicare and a supplemental policy Now. Because when, I turn 65 and didn't have Medicare, I could be denied for the Prescription part because I am DISABLED. Not fair, but the law.

Mike it right, in that his wife is not eligible for Medicare right Now because she didn't get it at the time she was eligible. You may received Medicare 1 or 2 ways. 1. is the date you are eligible and 2. anniversary date - which is usually January 1st.

First thing I would do is appeal the $ amounts disallowed to the insurance company. You have 30 days to appeal. I would also recommend an Attorney. My Personal opinion, is try to find an Medical Insurance Attorney. Look up your State's Lawyer Association, call them and ask them for an Attorney who specializes in Medical Insurance in your Attorney.

Good Luck!

Luci
PS Don't know if it was an uphill battle for your wife to receive her disability, but it dang sure was for me and I was determined to Win - I did!

[mike59]

Luci,

Yep, my wife went on disability in 2001 but wasn't eligible for Medicare until 24 months of being on disability (on the 25th month one becomes eligible). Of course, the rub is Medicare never informed us of this, never sent her a card, etc. So she was automatically put into Medicare Part A but only eligible for Part B, not enrolled.

So far, the insurance company hasn't told us much except my wife claims from 2003 on will be looked at again. I don't even know if it is legal for them to do that but I am assuming it is. I, of course, am thinking the worst and believe we will get stuck with a bill of several hundred thousand which would wipe us out.

I've called the State Bar Association to find an attorney who deals with medical issues/insurance. One bankruptcy attorney told us to sit tight because we don't know what the insurance company will do - although I seriously doubt they will just forgive any debt.

The situation stinks because had I know I'd have paid the Medicare Part B premiums of $96.40 a month and none of this would be happening.

We purchased our home for 170k and the city says it is worth 240k now although the price I believe we could get is 210-200k. The city just wants the property tax money rolling in.

Maybe I am just jumping the gun thinking the worst but I doubt it. I have to go through an expensive medical treatment in 2010 and that is looming as well but that won't be a screw-up like this is.

Take care all,
Mike

[LuciluS]

[COLOR="Black"]

Luci,
So far, the insurance company hasn't told us much except my wife claims from 2003 on will be looked at again. I don't even know if it is legal for them to do that but I am assuming it is. I, of course, am thinking the worst and believe we will get stuck with a bill of several hundred thousand which would wipe us out.

I've called the State Bar Association to find an attorney who deals with medical issues/insurance. One bankruptcy attorney told us to sit tight because we don't know what the insurance company will do - although I seriously doubt they will just forgive any debt.

The situation stinks because had I know I'd have paid the Medicare Part B premiums of $96.40 a month and none of this would be happening.

We purchased our home for 170k and the city says it is worth 240k now although the price I believe we could get is 210-200k. The city just wants the property tax money rolling in.

Maybe I am just jumping the gun thinking the worst but I doubt it. I have to go through an expensive medical treatment in 2010 and that is looming as well but that won't be a screw-up like this is.

Take care all,
Mike

Yea, I would play the waiting game & see if the medical insurance co. will pay . I know a lady who received her disability before mine & because dh's company, at that time, paid all of the employee's insurance, she felt is was better to stay on hubby's insurance who work for the same co.as my hubby and she was younger than me.She did not enroll in Medicare A & B.

I pay Medicare A & B which costs me $96.40 a month. However, I have a supplemental policy through AR Blue Cross/Blue Shield for Medicare only & it is $46.30 a month. It covers some of my medications & pays well on those. Only problem is there is they have a limited supply of meds listed and I pay for one of mine. The neat thing about is; they also pay alll my medical bills & sent me an EOB (explanation of benefits) which tells me what I owe. I have NO dealings whatsoever with the National Medicare.

Do NOT think your home is worth what the City tells you because, Yes, you are right they just want the money. If you want an rough idea of the value go to realtor.com & there is a place that says' hoe much is your home worth'. Just type in your address, city state, hit enter and it will estimate the value along with homes sold and homes on the market. I just took the 3 homes that have sold in our area this year, added the total square footage and the $ sold & divided the two, to come up the the avg. price per sq. ft. & mulitpliedthe $ amount by the sq. footage in my home. We are filing BK next month & feel thereis no need to pay for an appraisal, unless the Trustee requests it.

Just my thoughts and suggestions,

Luci

[mike59]

Thanks Luci!

I did a survey on homes in the area to get an idea. The city is crazy with what they value the homes at.

[mike59]

Hi everyone,

What we have found out is this: my wife was covered by my health insurance 100% until my status changed from short term disability to long term disability in September of 2008. We received no notification of the impact on our health insurance of that change of status from my former employer, the insurance company, or anyone else. The insurance company paid all of her health insurance claims for almost one year and sent us notices that they were paid in full. Almost one year later they sent new Explanation of Benefits (EOB) going back to September of 2008 stating she was eligible for Medicare (but not enrolled) and therefore Medicare would have paid X amount. See the example below:

"*Remark Code 50: Medicare Pays Benefits Before Your Group Health Plan. Since The Patient Did Not Enroll For Medicare Parts A And/or B, We Processed This Claim After Estimating How Much Medicare Parts A And/or B Would Have Covered.
Medicare payment was applied in the amount of $160.80"

There are roughly 139 claims and the total is hard to ascertain at the moment.

The insurance company is paying 20% of my wife's claims but, according to them, the 80% Medicare would have covered of the claims is our responsibility. The insurance company can't go back any further than September of 2008 but the bills from the period they can go back to amount to roughly 50k. We have not received any bills yet but anticipate them.

The kicker is the the insurance company admitted they made the mistake and paid claims without notifying us of any change in our insurance status because I went from an active employee on short term disability to an inactive employee on long term disability. If we had known of the change in status it would have been a simple matter of paying $96.40 a month to Medicare.

Take care all,
Mike

[lovebirds]

Hi everyone,

What we have found out is this: my wife was covered by my health insurance 100% until my status changed from short term disability to long term disability in September of 2008. We received no notification of the impact on our health insurance of that change of status from my former employer, the insurance company, or anyone else. The insurance company paid all of her health insurance claims for almost one year and sent us notices that they were paid in full. Almost one year later they sent new Explanation of Benefits (EOB) going back to September of 2008 stating she was eligible for Medicare (but not enrolled) and therefore Medicare would have paid X amount. See the example below:

"*Remark Code 50: Medicare Pays Benefits Before Your Group Health Plan. Since The Patient Did Not Enroll For Medicare Parts A And/or B, We Processed This Claim After Estimating How Much Medicare Parts A And/or B Would Have Covered.
Medicare payment was applied in the amount of $160.80"

There are roughly 139 claims and the total is hard to ascertain at the moment.

The insurance company is paying 20% of my wife's claims but, according to them, the 80% Medicare would have covered of the claims is our responsibility. The insurance company can't go back any further than September of 2008 but the bills from the period they can go back to amount to roughly 50k. We have not received any bills yet but anticipate them.

The kicker is the the insurance company admitted they made the mistake and paid claims without notifying us of any change in our insurance status because I went from an active employee on short term disability to an inactive employee on long term disability. If we had known of the change in status it would have been a simple matter of paying $96.40 a month to Medicare.

Take care all,
Mike

Be ready for appeals and lots of calls to congressmen and your state insurance commissioner.

[whipster1]

Hi everyone,

What we have found out is this: my wife was covered by my health insurance 100% until my status changed from short term disability to long term disability in September of 2008. We received no notification of the impact on our health insurance of that change of status from my former employer, the insurance company, or anyone else. The insurance company paid all of her health insurance claims for almost one year and sent us notices that they were paid in full. Almost one year later they sent new Explanation of Benefits (EOB) going back to September of 2008 stating she was eligible for Medicare (but not enrolled) and therefore Medicare would have paid X amount. See the example below:

"*Remark Code 50: Medicare Pays Benefits Before Your Group Health Plan. Since The Patient Did Not Enroll For Medicare Parts A And/or B, We Processed This Claim After Estimating How Much Medicare Parts A And/or B Would Have Covered.
Medicare payment was applied in the amount of $160.80"

There are roughly 139 claims and the total is hard to ascertain at the moment.

The insurance company is paying 20% of my wife's claims but, according to them, the 80% Medicare would have covered of the claims is our responsibility. The insurance company can't go back any further than September of 2008 but the bills from the period they can go back to amount to roughly 50k. We have not received any bills yet but anticipate them.

The kicker is the the insurance company admitted they made the mistake and paid claims without notifying us of any change in our insurance status because I went from an active employee on short term disability to an inactive employee on long term disability. If we had known of the change in status it would have been a simple matter of paying $96.40 a month to Medicare.

Take care all,
Mike

I think you have a case of bad faith. They should have notified you of any changes when they occurred. Probably some HIPAA violations also. Look for an attorney that Specializes in Insurance Bad Faith...don't go to Joe Blow, Attorney at Law. I see $$$ in your future although things look grim for you at this moment. Tell me what state you are in and I will look for some specialists if you wish.

[mike59]

THANKS!

Wisconsin.