Senior Care Insurance Agency

By Woodrow Wilcox

On October 24, 2017, I reviewed medical bill problem papers for a client from Dyer, Indiana.

The client provided a medical bill, a Medicare Summary Notice form, and an Explanation of Benefits from an insurance company.

The client bought a Medicare supplement insurance policy through our agency which became effective on August 1, 2017. Prior to that, she was not our client. A medical bill incurred on September 13, 2017 was not getting paid by her new insurance company. She wanted to know why.

I reviewed the papers and suspected that I knew the problem. But, I phoned the new insurance company to be sure. I was correct. Here was the problem.

Medicare sent the claims report to the old insurance company and never sent the claims report to the new or current insurance company. The old insurance company was denying the claims because the client no longer had a policy with it. The really interesting thing is that the Medicare Summary Notice forms said that Medicare was sending the claims report to the new insurance company, but Medicare did not do that. Instead, Medicare sent the claim only to the old insurance company.

This is a common problem with Medicare. I have handled many cases where Medicare did not start sending the claims report to the correct insurance company for six months. In two cases, Medicare failed to send the claims reports to the correct insurance company for over nine months. In one case, Medicare failed to send the claims reports to the correct place for nine years because the senior was very healthy and was not seeing a doctor.

I wrote a letter to help our client get the matter corrected. But, this kind of thing happens often because the federal government’s Medicare system is far from perfect. If I had not helped the senior, she would have been hounded to pay bills that would have been paid for her if the Medicare system worked well.

All the help that I gave this client was FREE OF CHARGE. This insurance agency takes pride in its reputation to “go the extra mile” for our senior citizen clients. If your insurance agent or agency does not give this high level of service to senior citizen clients, maybe a change to our agency would be a good idea