Tuesday, December 6, 2016

Lucy Grosz appeared on NBC Daytime Columbus

On November 18, 2016, Lucy Grosz appeared on Daytime Columbus regarding Medicare.  This applied to open enrollment for this year, but is relevant to anyone who is choosing Medicare coverage.  To see the full interview, click on the link below.


Medicare Deductibles change for 2017

Medicare has announced changes in deductibles for Part B and other fees.  For example, the Part B deductible is increasing from $166 to $183 for 2017.  Here is the full press release:


Monday, September 19, 2016

Medicare Marketing Rules

Many people are not aware that there are marketing rules surrounding Medicare.  The state of Ohio protects Medicare recipients and there are several things that agents are forbidden from doing:

1) No door to door solicitations are allowed.
2) No e-mails are allowed without written permission of the Medicare recipient
3) No marketing phone calls are allowed.
4) Marketing letters are allowed but no follow up phone calls to see if the letter was received are allowed.

These rules apply in Ohio, regardless of the product being marketed. This means that even if someone is only calling about a Medicare Supplement product, the call is not allowed by Ohio marketing rules.

If you have been receiving these times of calls, you can file a consumer complaint with the Ohio Department of Insurance.  Filing a complaint is the best way to stop these marketing practices.

Friday, July 15, 2016

Medicare Appeals - The Real Story

Medicare Appeals - The Real Story

If you are on Medicare and you have a service which is not paid the way you think it should be, or your have trouble with a Part D plan, your option is to do an appeal.  There are some tricks to this which most people do not know. 

First, there is a separate and distinct process, depending on what you are appealing.  Part D is a different  process than for medical claims.  So, let's talk about Medical claims first.

When a Medicare recipient goes to any provider for services, Medicare keeps track of those services.  On a periodic (not monthly) basis, Medicare will send out a Medicare Summary Notice.  This notice has information about all of the services you have had during the reporting period.  It can take several months for Medicare to send out this notice to you. The notice can contain multiple dates of service on it, too.

The most important thing you can do is to review the Medicare Summary Notice as soon as you receive it.   You may have bills for the previous quarter and not receive the notice until much later  This creates a problem, since according to Medicare, you only have 120 days from the date of service for you to appeal to Medicare. 

On the last page of the Medicare Summary Notice, there is information about appealing.  If you appeal, you must return a copy of the Medicare Summary Notice and all supporting documentation to the address on the Summary Notice. There is a date listed on the Notice that states how long you have to appeal.  Medicare must receive the normal appeal for that date and the appeal will be denied if you do not respond by then.  All appeals must be in writing and mailed.  Fax notifications are not honored.

Once the appeals vendor RECEIVES the notice, they have 60 days to even respond.  You cannot escalate your appeal before the 60 days is up. 

I have been successful in appealing Part D grievances with the Medicare Redetermination Request and Appointment of Representative form.  This has worked only for Part D.  What decisions have been made were concerning Late Enrollment Penalties (LEP) only. In addition, I was able to fax copies of the documentation in successfully.

The bottom line is this.  If you have a problem with Medicare, you are going to need an advocate to help you.  This is complicated, confusing and requires persistence to get problems resolved. 

If you would like more information, you can contact Lucy Grosz at 64-889-0934 or e-mail lucy@altavistaben.com.

Tuesday, July 5, 2016

Medicare appeals process is lengthening

Medicare appeals are taking longer

I have been working with several clients lately on Medicare appeals.  I am helping to facilitate the appeals because Medicare is denying services which should be covered.  In an article by Kaiser Health News, it was reported that there is a backlog of more than 700,000 appeals cases now.  I was not aware of this before, but claim denials have been occurring frequently since late last year.

You may start to get bills for services you think should be covered and wonder why.  When that happens, you will need an advocate to help you file a Medicare appeal.  If you are having trouble doing that, or you have filed an appeal and have not received a response, you are not alone. The backlog is expected to last until 2021.

Here is a link to an article which explains that there is a slowdown in processing Medicare appeals:
CBS news about Medicare appeals.

For further information about the process of filing an appeal, you can visit the Medicare web site or call us at 614-889-0934.

Thursday, June 2, 2016

What does balance billing mean?

Medicare and Balance Billing

What does the term balance billing mean with regard to Medicare bills?  Suppose you get a lot of testing done for outpatient services.  The first place the claim goes is to Medicare for approval.  If Medicare approves the expense, it then goes to your insurance company.  Any balance remaining after Medicare and the insurance company pay is called a "balance bill".  Under Ohio law, this cannot be passed on to the Medicare consumer. 

Whether or not balance billing can do done is controlled by state.  For example, the state of Florida allows balance billing and Ohio does not.  That means that if you get sick in Florida and don't have a medical plan in place that covers balance billing, you could end up with a bill for Florida services.

The plan choice you make can have financial consequences if you have not considered the concept of balance billing in your choice.  For more information, you can contact Alta Vista Benefits at 614-889-0934.

Wednesday, May 18, 2016

Medicare changing approved expenses

Medicare is changing what expenses they deem to be "Medicare approved".  I have been getting frequent calls about Medicare denying charges for services normally approved
and paid by Medicare.  What is interesting is that there have not been any publications or changes to medicare.gov that indicate a policy change has been made on covered expenses.

The way to correct this is to file an appeal with Medicare.  They can take up to 90 days to process the appeal. 

If you have a question about bills you are getting and you don't understand why things are not getting paid, you can contact Alta Vista Benefits for help at 614-889-0934.