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Were they trying to determine if there was someone else at fault in your accident that they could go after for reimbursement?
That's probably what it was all about.
Injuries from an accident could involve liability on the part of another party, and Medicare may investigate to determine if another party would be liable for your medical bills resulting from the injury.
I dont know anyone either but me and that other person I met a few months ago. A ins agent told me that if anything like that happened again I would have to hire an atty. only an atty would be able to found out why this nonsense was occuring. and I dont have an advantage plan just plain old medicare with bcbs as a supplement. .
ever since then medicare will always always deny some of the charges so dx cant take place with any accuracy, only guess work. and we still arent talking about anything expensive.
Per my bold of your text, you would think that Medicare should be able to explain this but apparently not. I'm wondering if one of your providers is/was suspected of fraudulent billing and the claimant names got flagged. This appears more likely than an issue over what Original Medicare covers, and how it normally handles bills.
The government is not always transparent! My daughter has complicated records that led to problems both with Homeland Security and Social Security. In the former instance, the airlines absolutely would not/could not explain (until someone took pity and did when she was 12 yo) nor could a social security agent explain (although I was prompted to guess) why she didn't pass a background check a few years later. We got lucky (received help), two paperwork fixes and that was it.
Willie, took another look to see you said this began with a tick bite from a tick that wasn't supposed to live in that area. Perhaps that claim failed a computer algorithm and there's no clear path to remove you from a Medicare 'watch list'? It's as good an explanation as any, I suppose.
I have Medicare Parts A & B and Blue Cross/Blue Shield Basic. I pay nothing for doctor visits and almost nothing for prescriptions. Medicare is my primary insurance and Blue Cross/Shield is my secondary insurance.
Did you have BCBS Standard when you were working? I think maybe the only difference is being covered if you travel internationally???
I know a few that have Federal Employee Health Benefit (FEHB) that stay on that instead of medicare part B because can be lower cost, especially if subject to IRMAA. FEHB benefit is pretty good and does not require medicare, Tricare requires part B medicare.
Currently, I am on a FEHB plan with medicare part B - the FEHB plan refunds up to $250/mo of medicare premium and IRMAA with Tricare picking up most of the deductibles/co-pays.
FEHB Basic option? We have the Standard option as our secondary to Medicare,,and it doesn't reimburse us for part B premiums. Our choice, though.
Do you feel you have better coverage that way or is it just for the international coverage? I will have to make that decision here in the next few years and I have been studying it and attending webinars. But, the interaction between Standard or Basic and Medicare is still somewhat of a mystery to me.
they would ask whose horse was it? did i have permission to be on the horse? am I sure I was really on a horse? where did I fall off? did I have permission to be there? why did I think i had permisdion to be there? and on and on and on every time they called. went on for months. At first I even offered to send a copy of a canceled check for board for the horse. vet bills, farrier bills etc. They refused and after that I had to answer the phone but the conversation never changed. BCBS said there wasnothing they could do and i was legally required to answer the questions. finally after 4 months or so they stopped and the hospital was paid. You are talking about only 2 hrs in the ER, 2 plain xrays of my hip, and a pair of crutches. That was it.
and no it wasnt an advantage program. Plain old medicare with bcbs as a supplement.
So it does appear it was an attempt by some third party, probably on contract to BCBS, that was trying to either root out some BS reason to disqualify your claim, or someone else they could sue to recover reimbursement from. So, it seems it wasn't Medicare harassing you, but probably some company hired by BCBS (since they claim they can't stop it). And the fact that it wasn't for a great amount is puzzling since Medicare paid the bulk of it and BCBS only the supplemental part. They probably spent more pursuing this than the actual expense of the claim.
So it does appear it was an attempt by some third party, probably on contract to BCBS, that was trying to either root out some BS reason to disqualify your claim, or someone else they could sue to recover reimbursement from. So, it seems it wasn't Medicare harassing you, but probably some company hired by BCBS (since they claim they can't stop it). And the fact that it wasn't for a great amount is puzzling since Medicare paid the bulk of it and BCBS only the supplemental part. They probably spent more pursuing this than the actual expense of the claim.
oh Im sure it hadto cost the investgative agency more than what they would save by paying the bill. It was a well known investigative agency in Kentucky. You can find the name. just google it. They investigate health care fraud. They are hired by medicare and bcbs as well as other ins companies.
I'm planning retire in two years (counting the days) so I've already starting Medicare research. And I plan -- I guess you could say, to "over insure." I'm keeping my employer health plan (which will become secondary) and signing up for medicare.
1) Because there's a penalty for life if God forbid you ever change your mind and want to sign up later....2) the secondary serves the purpose of medi-gap coverage.
"Expensive" is relative. I don't get why people say Medicare is expensive. It's not even $175 a month for health insurance. I'm single and my health insurance hasn't been $175 a month in DECADES.
What ticks me off to no end is that the BCBS policy I have -- the higher cost, higher tier one, which has "out of network coverage" is NOT the one that reimburses for the Medicare premium.
How is it that I pay a higher premium and do NOT get the reimbursement, when someone who pays LESS than me, GETS reimbursed. That's BS, IMO.
I could swap. Yes that's true. And friends/relatives say most doctors (or at least any doctor I'd likely see) are IN network anyway.
But I don't want to have to even think about or deal with whether my doc is in or out of a network....so for that I guess I pay through the nose.
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