Medicare is a federal program that helps over 44 million beneficiaries each year. Predictably, with a program of its size, there are beneficiaries that have Medicare complaints that can be difficult to resolve on their own.
With over 20,000 Medicare clients across 47 states, Boomer Benefits is always working to resolve Medicare complaints reported by our policyholders. Our Client Service Team deals with these tedious problems in a way that has earned us a continual 5-star satisfaction rate among clients year-over-year. This also means we can share with you, our readers here, about some of the more frequent complaints we see.
Let’s look at some of the most common Medicare complaints and how Boomer Benefits works to resolve them.
Complaint #1: Why is My Doctor Asking Me to Pay My Part B Deductible Again?
Oftentimes, doctor offices aren’t as well-versed in Medicare as you would expect. They know that Medicare Part B has an annual deductible that patients must pay out-of-pocket.
The office asks you to pay the deductible the same day as your appointment. Then next week you get a bill from your doctor’s office that says you still owe your Part B deductible.
How Boomer Benefits Can Help: This happened because Medicare had no way of knowing you already paid your deductible to the doctor. The doctor’s office must submit your claim to Medicare first. When billed this way, Medicare will process the claim without recording that you have met your deductible.
Another way this happens is that you pay your deductible to the doctor but another provider, often a lab facility, bills Medicare first. Medicare processes the claim for the other provider minus the deductible, and then that provider bills you for the deductible. You must ask your doctor to refund the deductible to you since Medicare applied it to a different claim.
When our clients contact us about an unexpected bill, we contact the doctor first to understand why. After determining what the issue is, we will work with Medicare and the doctor’s office to correct it. We do this by requesting the doctor office to reimburse the client the $183 dollars. The client then uses that money to pay the deductible to the correct provider.
Complaint #2: I Have A Higher Part B Premium but I Don’t Make as Much as I Used To
Medicare sets your Part B and Part D monthly premiums based on your tax return from two years prior. As of 2018, if you made more than $85,000 a year, you’ll have a higher monthly premium. However, when Medicare beneficiaries retire, they’re usually making less than what their prior tax forms indicate. This higher premium can be frustrating for beneficiaries.
How Boomer Benefits Can Help: We walk our clients through how to submit a request for reconsideration. This is a form that is sent to the Social Security office requesting a lower your Part B premium. The Social Security office reviews the form along with related documentation and decides whether to lower the premium. Many of our clients have been successful in lowering their Part B premium this way.
Complaint #3: I Received Unexpected Charges with My Medicare Advantage Plan
When enrolled in Medicare Advantage, you’ll pay copays for services as you go along. Your doctor copay might be $40 but then the doctor sends you down the hall for bloodwork. Then you get hit with another copay from the lab. This makes out-of-pocket expenses on Medicare Advantage plans hard to predict. They are often more than you originally planned for.
How Boomer Benefits Can Help: Sometimes when you enroll on your own without fully understanding how Advantage plans work, you may find that you are shelling out more copays on your Advantage plan than you had anticipated. The reality is, one visit can cost you multiple copays and/or coinsurance if there is more than one provider billing Medicare.
We can help by exploring other Medicare Advantage plans in your area to see if we can find you savings. We can also look at other types of plans, such as Medigap plans, that could significantly reduce your out-of-pocket spending and eliminate doctor copays.
Complaint #4: My Drug Copay Is Higher Than It Should Be
You get to the pharmacy to pick up a prescription and they say you owe much more than you were expecting. Sometimes the price the pharmacy is charging is right, other times it’s wrong.
How Boomer Benefits Can Help: We investigate to figure out if you’re supposed to pay that price or not. Often, we conference in the drug plan company for an explanation. One reason the price could be higher than you were expecting is that the medication is a higher tiered drug. We figure this out by reviewing your plan’s formulary.
If this is the case, there are a couple ways we try to resolve the issue. We can help you call your doctor to submit a tier reduction request to your plan’s carrier. Alternatively, you can ask your doctor to prescribe a similar drug in a lower tier.
Complaint #5: Medicare Isn’t Paying for My DME Through My Supplier
Clients of Boomer Benefits, particularly newer clients, don’t know that they may need to use a Medicare-approved supplier for durable medical equipment.
Medicare will only cover DME if you use a supplier approved by them.
How Boomer Benefits Can Help: The way we solve this issue is often dependent upon what kind of Medicare plan a client has. For instance, with a Medicare Advantage plan, we’d contact the carrier to find a contracted supplier approved by the plan.
If our client has a Medigap plan, our team will help find a Medicare-contracted supplier and guide the client through the process of obtaining their supplies.
Complaint #6: My Medigap Plan Isn’t Covering the Services Medicare Denies
Many beneficiaries think that Medigap plans pay for all the services and procedures that Medicare doesn’t cover, but that isn’t true. Medigap plans only pay for the gaps in Medicare on claims that Medicare has approved.
These gaps include deductibles, copays, and coinsurances. Your Medigap plan only pays after Medicare has first approved and then paid its share of the claim.
If Medicare doesn’t cover the service, the supplement is not allowed to make any payment on the claim either.
How Boomer Benefits Can Help: In this situation, our team makes sure the claim was billed correctly to Medicare. If it was, and still is denied, we find out the reason why. Then we educate you so that you don’t run into this problem again. We can give you a refresher on the services that Medicare doesn’t cover, such as routine foot care or cosmetic procedures, etc.
If the claim was billed incorrectly, which happens often, we work on your behalf to resolve this issue by contacting Medicare and your doctor’s office to ensure that the claim is resubmitted correctly.
Complaint #7: I Just Got Medicare And It’s Not Paying for My Doctor Bills
Newer Medicare beneficiaries who are still working run into this problem often. They enroll in Medicare while still on their employer plan. After they retire, they go to the doctor for a checkup and present their Medicare card thinking that Medicare is now their primary coverage. Later, the bill comes back denied by Medicare.
How Boomer Benefits Can Help: This usually happens because Medicare doesn’t know that they are the patient’s primary insurance instead of the employer plan. If the employer fails to notify Medicare that you are no longer working there, Medicare rejects the claim because it thinks it is still the secondary payer after the group insurance.
Our team will resolve this issue by placing a conference call to Medicare with the client to ensure their system reflects that Medicare is in fact primary. Then, we will contact the doctor’s office to have them resubmit the claim so that Medicare can pay their part.
Let Our Experts Solve Your Complaints
At the end of the day, Medicare is just like any other insurance in the sense of unforeseeable yet unavoidable billing issues. As beneficiaries have these Medicare complaints, it is all the more important to have an advocate like Boomer Benefits on your side.
We have a team of experts that work hard each day to make sure our agency’s beneficiaries don’t have to deal with these complaints on their own. Why waste any more time not having a Medicare plan and team that works for you? Contact Boomer Benefits today!