Friday, June 9, 2017

Does Anthem's withdrawal from Ohio affect Medicare clients?

Does Anthem's withdrawal from Ohio affect Medicare clients?
I have been getting a lot of questions since Anthem announced it was leaving the Exchange Market for under 65 clients.  The answer is No, it does not affect anyone who has an Anthem Medicare Supplement, prescription drug plan, or Medicare Advantage plan.  It is only for an individual plan for someone under 65.

Friday, May 5, 2017

American Health Care Act of 2017 (AHCA)

There are many questions surrounding the details of the Obamacare Repeal and Replace legislation.
If you are on Medicare, there are very positive changes that will impact you. 

This new law, if passed, will repeal the taxes on prescription drug companies and medical devices. The largest expense of most Medicare eligible people are prescriptions, so this should start to lower prices on drugs which is good news.  Prices should also decline on durable medical equipment, such as wheelchairs and hospital beds.

There has been much confusion about the coverage for pre-existing conditions with regard to Medicare.  Keep in mind that the majority of this legislation does not affect Medicare.  This is true with regard to pre-existing conditions on Medicare and any changes to pre-existing conditions only affect people who are not Medicare eligible.

Passing the bill through the House of Representatives is only the first step in the process of legislation.  I will provide more updates as information is available.

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

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.