Medicare Coordination of Benefits Issues and How to Get Them Fixed…

Recently, I received an email from a client that was new to Medicare as of 04/01/2022. He had his “red, white & blue” card and his Medicare supplement card in hand. His previous employer group health plan had been terminated and he was all set to ride off into the “Medicare Sunset”. Or so he thought…

My client began receiving a series of claim denials and rightfully so, was quite concerned. Pretty scary when you make that transition to Medicare from group coverage, or any coverage, for that matter. Typically, this is a smooth transition with few to no issues. But in some cases, there is a glitch. The good news is that it can be easily fixed.

Medicare has a database of information that warehouses medical insurance information for individuals that include group benefits, Affordable Care Act coverage, etc. When an individual transition to Medicare, this database is usually updated to reflect the old coverage has terminated and updates the new coverage to coordinate with Medicare. Medicare then pays it’s share of claims and bills the other insurance appropriately.

But sometimes this is not the case. As in the case of my client, there was a disconnect and Medicare was not recognizing that group coverage was no longer primary. This was causing her claims to be denied by Medicare.

The solution in most cases is simple. We did a 3-way call to the Medicare Benefits & Coordination Recovery Center at 1-855-798-2627. My client was asked a series of identifying questions, confirmed the situation and provided the required information. On the call, the helpful representative was able to update the record to reflect Medicare as the primary insurance. In approximately 10 days, the providers will be able to bill Medicare and the Medicare supplement, and the issue should be corrected.

This issue typically affects individuals with Original Medicare and a Medicare supplement. On occasion, this may happen with individuals that participate in Medicare Part C or Medicare Advantage plans. While not as common, the solution is the same as with Original Medicare and a Medicare supplement.

If you have any questions related to this topic or any other Medicare topic, feel free to reach out to us at 800-791-6850, email me at [email protected] or message us on Facebook at Liberty Medicare Advisors.