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Medicare, Medicaid, Life and Health Insurance/Who pays first - Medicare or Kaiser

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Question
Greetings Mr. Pedit --
My husband has Medicare and received his health care from kaiser HMO Medicare Plus.  He has been on oxygen therapy since June 2012. Shortly after starting this therapy with the oxygen tanks he asked his physician if he could approve a portable oxygen generator.  He was given a referral noted as non kaiser pharmacy and told he could order his DME.  Well the vendor hasn't been paid and is on the "Medicare - Kaiser" merry-go-round.  Medicare says they are not primary.  Kaiser says they are not primary.  Needless to say, the vendor is now asking us to pay upwards of $3000 and is unwilling to accept partial payment while we run through the appeals hoops.  I have no reason to believe that this vendor does not know how to file the billing with the CMS, but would really appreciate knowing the secret codes to getting this resolved. I've called Medicare numerous times and while the folks on the phone lines are polite and courteous, beyond reading back to me what is in the computer record are not that helpful.  It seems to be impossible to get the vendor, Kaiser, and CMS all on the telephone together for a conversation and in my mind a timely resolution.

Thanking you in advance for any assistance and guidance you might be able to provide.

Brenda

Answer
Hi Brenda
There are some differences in regulations between States.  I am in Michigan and therefore am referring you to the Maryland group of trained Medicare counselors.  Call 1-800-243-3425 and you will get the nearest office to you.  Make and appointment with one of their counselors and they will  find the problem and assist you with any appeals.

John

Medicare, Medicaid, Life and Health Insurance

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John Pedit

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Am an expert on Medicare, Medicare HMOs, and Medicare supplemental insurance. Also have extensive knowledge of Medicare especially in Mich. Have knowledge of COBRA and the Portability Act

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Council about 300 persons yearly and do many presentations on Medicare

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