Ask a Medical Biller: Rage against the Medicare Advantage Plan

I bought a specialty wheelchair for my husband and paid the Medicare copay of $500-ish. Afterward, I got notice that he qualified for Medicaid going retroactive to before the day that I paid for the wheelchair. Will that cover the wheelchair? If so, how do I get my $500 back?

The answer to your first question is maybe. There are so many different programs under Medicaid that unless it’s spelled out on the letter from Medicaid, you probably have to ask. If you look at that letter, you should be able to find your case manager’s name and number at the bottom. Give them a call, and ask if the program your husband qualifies under covers durable medical equipment. If it does, you’re golden.

The other half of your question is a little trickier, depending on your provider. Wheelchair providers are usually pretty good about this, though. Call up the billing office, and let them know that your husband has Medicaid now, and request that the bill be sent to them. The Medicaid eligibility system has some glitches, so when a person first qualifies, it will sometimes show the wrong effective date. If that happens, ask for a courtesy billing to Medicaid. Basically, you’re asking them to humor you. Make sure you write down the date that you called and the name of the person you talked to, and then follow up in a month. If Medicaid has paid, request a refund. If they haven’t, talk to your Medicaid case manager.

I signed up for a Medicare Advantage Plan this year, and now I’m regretting it. Is there any way that I can unsubscribe from it?

Actually, you can! Between 1/1 and 3/31, you may switch your Medicare Advantage plan or drop it altogether ONCE. Remember that if you drop your Medicare Advantage plan, original Medicare does NOT include prescription drug coverage. You will want to research and enroll in one by that 3/31 deadline. Medicare.gov offers amazing tools and information for assisting people who qualify for Medicare. Dropping to original Medicare also means you are liable for the Medicare copays, deductibles and coinsurance amounts. You will probably want to look into a Medicare supplement policy. Yes, they are expensive, but so are medical bills!

If you choose to go to a different Medicare Advantage plan, do your research. Think about the doctors you have whom you really want to keep. Call their offices, and see if they accept the new Medicare Advantage plan as in-network. Do you know anyone already on the plan? Ask them about customer service, networks, and problems. In Benton and Franklin Counties in 2021, the only options for Medicare Advantage plans are through Humana and Community Health Plan of Washington, as well as a plan through United Healthcare for those who also have State Medicaid.

Please be aware that Medicare supplement policies do NOT cover secondary to a Medicare Advantage plan. If you have a plan that isn’t specifically a Medicare supplement—perhaps through Tricare or Premera Federal—you will want to call them and ask if it will cover secondary to a Medicare Advantage plan. Don’t waste your money on a policy that won’t cover anything!

REMINDER: Don’t throw away your old insurance cards! If you switched plans, take a Sharpie and write the effective years on your old cards, and put them in a file folder (the one where you save your insurance Explanations of Benefit will work—you do save those, right?). Keep them for seven years. Yes, I said seven.
Timely filing of health claims is typically one year, but not all insurance companies have that rule, and medical providers are required to keep your records for seven years. If you run into a snafu down the line, you’ll be grateful you have them!

KyriAnne MW Boothroyd has been billing health insurance since 2007, and is a strong believer that the fact that people are forced to make health decisions based on finances is one massive problem that America needs to solve. You can contact her with questions at kmwboothroyd@gmail.com.

Photo by marianne bos on Unsplash