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Perfectly Imperfect Life..........

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Wednesday, November 5, 2014

A Rare Appearance on the Soap Box! Part Deux......Reformed HealthCare Humph!!

 
More Medical Insurance Issues,
so you may want to turn back NOW!
But they are different from before.
Reformed Healthcare, really?  HA! I think not!
 
T finally had his Social Security Hearing in July, Judge qualified him as an Adult Disabled Child in August. YAY!!
Received paperwork along with Medicare Card saying that
Medi-cal would end October 31, 2014,
Medicare would start on November 1, 2014.
Hot dog, party time. Back to his specialists that he has had forever and not been able to see due to their not accepting Medi-cal!!
 
Went to purchase a Supplement Plan/Medi-gap for that 20% Medicare doesn't cover. Which if it were just the Dr. visits, no biggie, but if he were to end up in the hospital (Heaven forbid) that can add to thousands.
Something M is dealing with currently for her
exploratory surgery she had this year
prior to her receiving Medicare.
No problem ~ went to the usual agency to purchase a Supplement in the beginning of October so we would be sure it would start the same time as Medicare on November 1, 2014. Had just done the same thing with M so thought it would go as easily. HA!
 Dealt with a newbie (just my luck), filled out paperwork. Thought yay another one I can relax about regarding Medical Insurance.
 
The last week of October comes, nothing received in mail from Supplemental. Called Agent, he said there were a few mistakes but that he corrected them and T would have his Supplement in effect by November 1st.  I hung up and started thinking about this.
 I decided to call the head Agent. She said that the Supplemental had turned T down due to lack of coverage......HUH? 
I was just told everything was hunky dory!
I said what "lack of coverage".  Prior to Medicare he had Medi-cal, prior to Medi-cal he had Blue Shield, prior to Blue Shield he had Tricare since 1994, prior to that he had Military Dependent Medical...He has NEVER been without
Medical Insurance since birth!
No lapse has ever happened.
 
She explained that his Medicare card effective date is June 2013.
The Supplemental is saying he has had lack of coverage for 18 months by a supplemental plan. Therefore he would have to go thru an underwriter to be approved. If he had applied for the supplemental during the 6 month window after receiving Medicare he would automatically be approved.
 
Hello, is anyone home in there!
He did not even qualify for Social Security in 2013.
We just went to court 4 months ago!
 The Judge approved him just 2 months ago and
 retro'd his disability back to 2009,
but Social Security would have an effective
retro date of June 2011.
Now, you have to be on Social Security for 2 years
before being eligible for Medicare,
so that is where the effective date of June 2013 came into be.
Can the company not understand even with all the paperwork I submitted giving the hearing date, dated letters from this year, etc. Hell no, all they can see with their blinders is June 2013,
which makes it 18 months without a supplement plan.
 
So it went to the underwriter.
He was denied due to pre-existing conditions.
Duh, he's 26 and on Medicare!!!!!!!!
 
I asked what do we have to do to get him eligible? She replied you can't do anything, they will only go by the date printed on his Medicare card. He will NEVER be eligible for a
supplement/medi-gap policy.
Needless to say I went numb, had a panic attack and fell to the floor.  How the f**k can this be? I thought Obama care prevented insurances from turning down anyone with pre-existing conditions. OH, but I was told, that is only for Obama care and Medicare and supplements did not fall under that policy. 
 
Of course not, think The President would ever do something that made sense?
All I could think of was thousands of dollars in hospital bills, should he (again, Heaven forbid) end up in the hospital.
 
A few hours later the Newbie called and asked if I had ever heard of Medicare Advantage, I said no. He tried to describe it to me over the phone, but it was clear he didn't know the plans.
 He asked to meet me at Burger King in a couple hours - 5:30....
I thought why BK?
Why not the office, is this guy legit? 
Is this under the table?
Let's just say I don't trust many people anymore and
 don't believe much that comes out of anyone's mouth. 
Met him at BK. He had two plans with their handbooks.
He flips thru the first while saying these plans are free,
they don't cost you a dime.
RED FLAG 
I asked then why does it say the monthly premium is $45?
He said just ignore that you don't have to pay it.
RED FLAG
He then says I think you will like this one better,
closing the first and opening the second.
 
As he flips thru it he is rattling off; it has dental, vision,
oh look even a gym you can join for free
RED FLAG
 
I was trying to keep up and read the pages as he flipped
( I needed to be Reid from Criminal Minds
 to read as fast as he was flipping!). 
I asked about Hospital coverage.
When he couldn't find it in the book I did.
Frist 45 days are free, 46 - 56, $100 each, then $75 thereafter.  If your in the hospital for 45 days...give it up you're a goner. 
 
THEN the most important question.
Are T's 3 Drs. on this plan?
Primary Care - yes
Psychiatrist - unknown
Eye Dr. - unknown
 
He proceeds to say ''but since this plan is free and you won't be paying for a supplemental you can save that money and see his uncovered Drs. and pay out of pocket''.
Yes, that made sense. But I still had a ton of questions that he sidestepped anyway he could. 
He keeps reminding me you can't wait to long
because Open Enrollment is now!
OK dude I got it, but I'm not jumping thru any hoops
until I have exhausted ALL my options and talk to whoever I can to try to understand why and if there is a way around this "NEVER" able for a supplement plan thing. 
 
OH, and by the way if you sign up with Medicare Advantage, you lose all Medicare Benefits.  Scary.
But why is it scary. It's not like we have any experience with Medicare. It's just that we have heard that word most of our lives and never heard of Medicare Advantage.
Basically the "kind of" known vs. the unknown.
the lesser of two evils? 
 
 T, M and I headed for Social Security
first thing Tuesday Morning.
Basically they can't do anything.
Was told to call "HICAP"?
I did, right there in the parking lot
(secretly hoping to be told come on over)
but ended up making an appointment with a Medicare Counselor. Of course, she wanted it to be Nov. 10 - just happens to be my oldest Son's Birthday and we will be spending the day with him,
so ended up with a Nov. 14 appointment. Wish it were sooner,
I want this fixed either way so I will be ready for
the next crisis that arises.
Realize this originally started Monday afternoon, an hour after I had just resolved an incompetent issue with another business.....I won't bore you with the details from Monday morning that had me ready to shoot my brains out!
Let's just say as I thought I could take a breath, the above started.
I called the Head Agent back to see if she could answer my questions that the Newbie couldn't.
Left a message, never received a call back. 
Guess that means there is no money in it for them.
 
 
I called T's Social Security Atty. for any info I could glean from them. None to give.
 
I called Medicare and was referred to a phone number, since they couldn't help either.
That number turned out to be "HICAP",
"oops, already talked to you and have an appt. bye"
 
Hey, I'm just trying to get pointed in the right direction here!!
Someone throw me a bone!
 
I researched this Medicare Advantage Company on line.
The program is through the county,
unsure if that's good, bad or indifferent.  
All it had is what was in the book I already had.
I decided to call the company up.
In amazement a real person answered!!!
There were no prompts to try to get thru...I was so confused.
Didn't they want to know if I spoke Spanish? 
What button am I suppose to push?
 
I calmed myself and got it together and explained my situation.
He was most pleasant and he didn't have to go ask a supervisor for the answers to my questions!
 Am I hearing this right? 
I must be dreaming.
Now remember the Newbie was pushing the current open enrollment date on me. Juan, yes, his name was Juan (do I hear birds singing? ocean waves?)   Anyway, Juan said when and IF I choose their plan to call him back and he could fill out all the paperwork over the phone and it would be effective the 1st of the following month, not January 1st, 2015 like The Newbie had told me.  Hmmmm 
Another Newbie RED FLAG

I/we haven't decided on what to do, I woke up with more questions for Juan this morning and will be calling him today. Well, he said to call and ask for him personally...
 Really girls!
 
I'm sure there's a buck or two in it for him should T sign up. But that's all anybody ever wants anyway. Might as well give it to someone who can actually answer my questions.
 
I also called his Specialists to verify whether or not 
if they accepted this plan.
Neither the Psych or Eye Drs. offices and ever heard of it.
I also wanted to find out what it would cost for visits without insurance.
Let's just say, luckily he only sees the Eye Dr. once a year!
Without having to pay for a Supplemental,
 that money will more than cover the Psych visits.
 
I will be rereading this 100+ page handbook
for the 4th time and most likely many more times,
and wait for our appointment with the
"HICAP" counselor prior to making any decisions.
 
And just plain trying to keep my head from exploding
PLEASE if anyone out there has been through this
or has any information...HELP!!!!

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