Community Chat

[pieman]

I have Medicare plam F, I also purchased the perscription plan.

I then purchased United as secondary and their drug plan too..

I am pretty much covered, except for those 2 scripts that I take..

As I said,,,the Protonix people did send me a card, to use for 1 year, 70% off the cost//

Zetonna also has one, which I downloaded but am waiting for the regular card as well..

I just wanted to make sure I was okay with using them..

You know, you go to these pharmacies and they try to tell you you can't use them, just to get full price..

With insurance, for my Protonix, I was paying 380.00, I kid you not...

I'll use the two cards and I will probably be better off than I was when I had the workplace insurance...

Thanks Carmie...

Have a good weekend!

[Carmie]

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@pieman wrote:

I have Medicare plam F, I also purchased the perscription plan.

I then purchased United as secondary and their drug plan too..

I am pretty much covered, except for those 2 scripts that I take..

As I said,,,the Protonix people did send me a card, to use for 1 year, 70% off the cost//

Zetonna also has one, which I downloaded but am waiting for the regular card as well..

I just wanted to make sure I was okay with using them..

You know, you go to these pharmacies and they try to tell you you can't use them, just to get full price..

With insurance, for my Protonix, I was paying 380.00, I kid you not...

I'll use the two cards and I will probably be better off than I was when I had the workplace insurance...

Thanks Carmie...

Have a good weekend!

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Whoa Nellie!! If you have Traditional Medicare and supplemental Plan F and  Medicare  RX coverage, you do not need a secondary insurance plan.  In fact, it is not legal for insurance companies to sell you another plan.

You are only allowed to purchase a supplimental plan for traditional Medicare And an RX plan OR a Medicare Advantage Plan if you do not want Traditional Medicare.

If you have coverage at work along with your Medicare that is okay, but you cannot buy a self pay plan in addition.

You need to call your insurance companies and find out which plan you want to keep and what you want to drop.  You are illegally over insured and all of that insurance is not necessary.  You are paying for insurance that you can't ever use. 

[hyacinth003]

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@moon_gazer wrote:

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@Carmie wrote:

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@KathyPet wrote:

OK so you have received a refund for part of the money you paid up front for your surgery because your insurance company or companies paid the claim that was submitted giving you a credit balance on your account with the eye clinic/doctor but not all of the claim has been paid and it has been 9 months.  have you called the insurance company to determine what the hold up is in getting the remainder of the claim paid?    9 months is a extraordinary amount of time to have a claim outstanding.  WHy has the insurance company not paid the remainder of the claim?  IT is certainly your responsibility to determine why the remainder has not been paid.  YOu need to call the insurance company and find out what the delay is. THe clinic/doctor is not going to refund your money until they get payment from the insurance company.  THey are wanting to be paid and if they do not have the insurance payment they are not going to issue you a refund.  THe problem lies,with the insurance company.  YOu have already said Medicare will not approve the claim for the second eye surgery and yet you want a refund .  WHy will Medicare not approve the claim?

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Yes, she should call to find out if the claim has been paid or even received.The Provider is responsible to send the claim to the insurance co.  When they receive the claim, insurance will issue an EOB by law within 30 days.  When there is coordination.of benefits, the providers sometimes don't follow up by submitting the claim to the secondary ins co.

My guess is that is what happened here. If Medicare does not cover something, she will get an EOB stating the claim has been denied and why.  If Medicare received the claim, but needs more information to process the claim, they will notify her in writing.

Experience tells me that the clinic dropped the ball.  Her account is showing paid in full on their books and they closed the account. The OP needs to light a fire under the clinic's behind to get them motivated.  Her problem is quite common.

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Believe me, I have tried to light a fire under the business manager of this clinic!  You are so right - they have their money for this and they have not gotten in any hurry to refund what is due me. That is why I came here to post  wondering if there is anything else I can do, short of hiring an attorney, to put the fear of God in these people. I know that eventually I will receive final payment, but I still think there needs to be some sort of repercussion to the clinic for the manner in which they have handled this whole situation. I have been a patient at this clinic for over 15 yrs., but will no longer be once this is closed.

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I am coming in on this a day late and a dollar short!

But, how about speaking to the doctor?  You are getting nowhere with the business manager.  Doctors don't always know what their business end is doing!  Send the doctor a letter and put "confidential" on it.  They generally don't want their patients put through the wringer like this.

Hyacinth

[pieman]

Carmie..

I phoned Medicare last evening..

I asked them wxactly wjat their little red , white and blue card is suppose to cover..

She told me hospitals and whatever..and only 80%...

That is why I purchased the United Health Care Plan as my secondary insurance., along with the drug plan...

I am entitled to a secondary insurance,

Medicare does not offer any drug plan.

I do not work, so I don't know why you keep thinking I do..

I've done nothing illegal..

[Carmie]

@pieman Maybe I am not understanding you or you me.

Your red, white and blue Medicare card covers the whole inpatient hospital bill except for a deductible which is $1316.  This is Medicare Part A.

If you have Medicare B it will show on your card too.  This covers Out patient services at a hospital or doctor office at 80%.

Some people have Medicare Part D which covers RX drugs. You have to pay extra for this plan.

Now, in order to have coverage for the inpatient deductible and the 20% coinsurance left after the Medicare payment, you purchase a SUPPLEMENT.  From what you have written, you purchased PLAN F.  This is an excellent plan.

 If you did not pick up Medicare Part D, you can buy RX coverage.  

There is no secondary insurance allowed if you have Medicare.   You are allowed  1  insurance plan to Suppliment Medicare and 1 RX plan to cover drugs.

Why do you have two coverages for drugs?  Do you also have another plan for hospital and doctor services?

No, you are not doing anything illegal.  If you have more insurance than you're supposed to, the insurance companies are illegally selling it to you.  THEY are not allowed to do this.  The law in in place to keep insurance companies from ripping off senior citizens,

You called Medicare.  They would have idea of whatever insurance you have in addition to theirs.

So far you mentioned Medicare and Supplemental Plan F.  That along with one RX plan is what you are allowed.  Anything else is not necessary.

If you are employed, which you said you are not. The laws are different...that is why I mentioned it.

if you only have one RX coverage and discount cards sent by the drug companies, that is okay.

[pieman]

And the saga continues..lol

Okay..

I am retired,,,

Medicare sent me the card...A & B..

I know there was no drug plan pffered with it, I also knew they only pay 80%.

I then purchased from United, the supplemental insurance....to take care of what Medicare does not.

I then purchased, separate, the RX plan...also from United.

All this came through AARP.....

I know many who have purchased a secondary insurance, such as I...

The plan F is suppose to be very good.....

All I know is Medicare said when I go to a doctors or hospital, make sure I show them both insurance cards...

So, thats what I will do...

If someone is going to get screwed, pardon my English, I would think its them not me,

As for the RX , United told me that I had to purchase that separate  and that Plan F had no coverage,,, Did they lie to me?

[NYC Susan]

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@pieman wrote:

And the saga continues..lol

Okay..

I am retired,,,

Medicare sent me the card...A & B..

I know there was no drug plan pffered with it, I also knew they only pay 80%.

I then purchased from United, the supplemental insurance....to take care of what Medicare does not.

I then purchased, separate, the RX plan...also from United.

All this came through AARP.....

I know many who have purchased a secondary insurance, such as I...

The plan F is suppose to be very good.....

All I know is Medicare said when I go to a doctors or hospital, make sure I show them both insurance cards...

So, thats what I will do...

If someone is going to get screwed, pardon my English, I would think its them not me,

As for the RX , United told me that I had to purchase that separate  and that Plan F had no coverage,,, Did they lie to me?

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If you have Medicare, a supplemental plan, and a prescription plan, you're fine.  It sounded as though you had more than that.  I think that may be why things got confusing here.  @Carmie has explained it all very well, IMO.

And yes, show both cards when you need medical care.  Medicare will pay their 80%, and then your supplemental insurance will kick in. 

[Carmie]

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@NYC Susan wrote:

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@pieman wrote:

And the saga continues..lol

Okay..

I am retired,,,

Medicare sent me the card...A & B..

I know there was no drug plan pffered with it, I also knew they only pay 80%.

I then purchased from United, the supplemental insurance....to take care of what Medicare does not.

I then purchased, separate, the RX plan...also from United.

All this came through AARP.....

I know many who have purchased a secondary insurance, such as I...

The plan F is suppose to be very good.....

All I know is Medicare said when I go to a doctors or hospital, make sure I show them both insurance cards...

So, thats what I will do...

If someone is going to get screwed, pardon my English, I would think its them not me,

As for the RX , United told me that I had to purchase that separate  and that Plan F had no coverage,,, Did they lie to me?

---

If you have Medicare, a supplemental plan, and a prescription plan, you're fine.  It sounded as though you had more than that.  I think that may be why things got confusing here.  @Carmie has explained it all very well, IMO.

And yes, show both cards when you need medical care.  Medicare will pay their 80%, and then your supplemental insurance will kick in. 

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It sounds like you have everything ok.  I still don't understand why you said you have two RX plans though.

Supplimental insurance is not secondary insurance.  They are two different things. Plan F is VERY good Supplimental plan. No one lied to you.  You have to purchase RX coverage, but you are only allowed to purchase one policy.

I hope this clears it up for you,  You cannot get into trouble for purchasing insurance, the insurance companies will.,.if they sell something to you that you do not need.

[pieman]

Susan...

Don't remember saying I had to RX Plans, if I did it was am error on my part.

I purchased a seperate plan for that..

What I did say was that I had 2 cards from two companies..

Protonix and Zetonna//

Its suppose to save me "big monies" , (so they claim) because those 2 drugs are not on my United health Care Insurance.

Did Carmie go blow her brains out, because of this back and forth?! lol///

Have a great week to you both...

Thanks...

[NYC Susan]

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@pieman wrote:

Susan...

Don't remember saying I had to RX Plans, if I did it was am error on my part.

I purchased a seperate plan for that..

What I did say was that I had 2 cards from two companies..

Protonix and Zetonna//

Its suppose to save me "big monies" , (so they claim) because those 2 drugs are not on my United health Care Insurance.

Did Carmie go blow her brains out, because of this back and forth?! lol///

Have a great week to you both...

Thanks...

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I'm not sure where the confusion came from, but it sounds as though what you have is just fine.  As for your Rx's that aren't covered, I hope those cards do help!

All of this can be very confusing!  I think @Carmie did a great job of explaining, and I'm sure she was happy to help.  

I wish you a wonderful week too!  :-)