@catwhisperer wrote:
Such a sad story. Everyone's situation is different, so I am not in a position to judge or make suggestions. Gov't. funding/low income help also varies by state. All I know for a fact is what I and DH are going through.
DH was in the hospital two years ago. I am his full time caregiver. We have a Medicare Advantage plan with a supposedly annual out of pocket max. That is a joke. We have paid way more than our "max". We cannot afford a "supplemental" plan. We are still receiving medical bills in the mail because our insurance carrier claims the charges were "not necessary", or "Not authorized". HUH???
Our county offers to pay full time caregivers a wage, but I do not qualify because they say our income is over their limit. I told the lady that our rent is over half our monthly income, but they do not take that into consideration. That is just not right.
After reading the replies on this thread, @Cakers3 seems to be only one of the very few who understand the struggles many of us are dealing with.
@catwhisperer I think I understand what happened in your case. It sounds like your DH had a HMO Advantage Plan. With this type of Medicare you cannot purchase a Supplement and don't need one and it is against the law to have an Advantage Plan and a Supplement.
With an HMO you MUST coordinate your care with your primary care physician( PCP) That means you need permission and a referral to see any other doctor other than your PCP. That means all services MUST be authorized before you can receive them.
If you do not follow the rules of the HMO insurance plan, you will not receive any or very little payment for your medical bills, unless it is a life or death situation.
You have received denials because your DH did not follow the terms of his coverage. It is important to understand how your insurance works. In the future, always see your PCP before you attempt to receive medical care....unless it is an emergency...life or death situation. Then call the PCP immediately and explain what happened.
If a claim denies and you feel it was an emergency situation, write a letter of appeal to the insurance company and they will investigate the charges...and possible pay your claims.
You only have 60 days to appeal a claim after it has been denied or processed.