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Old 02-20-2013, 04:19 PM   #1
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Question bcbs forcing members into medicare

On July 17 2012 I had a foot procedure performed with a local physician in Hyannis Ma.This procedure was processed thru my BCBS health insurance as a required occurrence.However on this procedure BCBS elected not to pay the claim and I received the balance of the bill from the local physician for payment.

I contacted BCBS to inquire why the claim was not processed and was informed that BCBS will no longer process my insurance claims for ma as the primary payer,This is due to my being qualified for Medicare Insurance as a Social Security Disability recipient.BCBS informed me it did not make a difference that I was not enrolled for Medicare Insurance or I had full group health insurance from my company.The reply was that because I qualified for medicare insurance BCBS will no longer be the primary and will become secondary to Medicare.BCBS informed me this was due to a recent law that was passed that allowed them to process claims as a secondary provider regardless if the individual was enrolled or not in Medicare Insurance.Social Security automatically enrolls recipients in Part A after 24 months on disability benefits You also have the option of picking up Part B at that time.I am not enrolled in Part B due to the full group insurance my Company provides me.

I have made numerous calls to Medicare,BCBS,Social Security Etc..All have recomended to aquire Medicare Part B to protect myself and my family

My questions are as follows
1, What recent law was passed that allows BCBS to accept a preuimin from my company for my full group health coverage as the primary payer,yet is able to become secondary payer simply because I am disabled and automaticly qualifiy for medicare Insurance.

2.Is this change only for disabled Social Security recipients,or for all retired people over 65 years of age who would qualifiy for Medicare

 
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Old 02-20-2013, 04:56 PM   #2
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Re: bcbs forceing members into medicare

i don't know the answer to this question but I do think that medicare or bcbs should be able to answer the question. I think it is terrible that bcbs did not advise you of this before hand. I would appeal their decision and maybe you will get some justice because they never advised you of this decision before hand. good luck

 
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Old 02-20-2013, 05:09 PM   #3
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Re: bcbs forceing members into medicare

It may seem complicated but it really isn't. I had a similar issue - not quite the same though. However, if you are on Medicare - whether you want it or not, it is your primary UNLESS you opt for a Blue Advantage or some other medicare provider. I don't know when this took effect as I am 67 so I wouldn't have a reason to know.

Check to see if you can opt for one of the other plans that don't cost you extra. I'm not sure whether disability qualified medicare people can get the Blue Advantage , etc but am sure they can tell you. That way you wouldn't have to pay more and would be covered on both sides.

 
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Old 02-20-2013, 06:19 PM   #4
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Re: bcbs forceing members into medicare

I am currently enrolled in a company provided group health plan
This is a union contract benifit to all disabled employees
BCBS has always processed claims as the primary payer
However they said due to new laws passed
I am 62years old
What new law allows them to do this?
How can BCBS force you into medicare just because you automaticly because you receive ss
This does not seem legal that BCBS can force people into a additional insurance while accepting a payment to provide full coverage
Thanks for your reply

 
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Old 02-21-2013, 07:40 AM   #5
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Re: bcbs forceing members into medicare

it might be the affordable heathcare act they are using as an excuse, I am not sure. This is not your issue. YOUR issue is that they never notified you before the medical bills come in. That seems to be the only ground you have to fight getting these bills paid. If you are in the union get your union reps to fight this for you. BCBS should pay this one time and from here on in you take out Medicare as well.

 
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Old 02-21-2013, 06:27 PM   #6
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Re: bcbs forceing members into medicare

Medicare - if you are on it - is always the primary coverage. But if you have both medicare and your group policy, medicare should pay its share and then the BCBS should pay the balance. Maybe you just need to refile in the proper order. THat's what happened to me. Your HR department shouldbe able to help you.

And be sure and get your medicare card.

 
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Old 05-18-2013, 09:06 AM   #7
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Re: bcbs forceing members into medicare

No that is incorrect. Medicare is not always primary. I know this from my experience as a medical biller. If your insurance is from a job that is primary over medicare.
Sometimes medicare and the insurance company fight amongst themselves on who is primary and it is the patient that suffers.

 
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Old 05-18-2013, 11:56 AM   #8
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Re: bcbs forceing members into medicare

But the OP is on SSDI and I think that is the difference. And in MA where they have mandated healthcare also. So I think this is a little different.

 
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Old 09-20-2013, 06:15 PM   #9
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Re: bcbs forcing members into medicare

I'm having the exact same problem. I didn't know my policy at BCBS changed when I became eligible for medicare. No notice was received. I'm not 65 yet, but became eligible for medicare since I've been on disability for two years. I'm sure there are others in this same situation. Anyone have any suggestions.

 
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Old 09-20-2013, 06:45 PM   #10
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Cool Re: bcbs forcing members into medicare

Quote:
Originally Posted by lemans455 View Post
I'm having the exact same problem. I didn't know my policy at BCBS changed when I became eligible for medicare. No notice was received. I'm not 65 yet, but became eligible for medicare since I've been on disability for two years. I'm sure there are others in this same situation. Anyone have any suggestions.
Just a Canadian here, but I know contract law and governments (somewhat).

Reaching "65", and, "being on disability" are clearly major factors affecting your healthcare coverages. Just prior to or on reaching those categories, while it would have been nice to have received layman's language literature about the implications, I suspect you're "on your own" for figuring it out and doing what's appropriate (eg. I gather you are not automatically enrolled in Medicare but need to 'sign up' for it, at 65 and/or "being on disability"). With us, we're advised to enroll for our age 65 benefits (government pension(s)) almost a year ahead of time (to allow for 'processing').

Nobody hardly does this in practice (beforehand anyway) but group/work insurance doubtless has many pages of fine print you ought to read (since it's your money supporting such plans) which go into the whereases and wherefors of the process in some convoluted fashion I'll bet.

sf

 
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