Medicare, Medicaid, Insurance, HMO problems - Health Care: UK - Health/Fitness

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About John Pedit
(Top Expert on this page)

Expertise
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

Experience

Past/Present clients
Council about 300 persons yearly and do many presentations on Medicare

You are here: Experts > Health/Fitness > Health Care: UK > Medicare, Medicaid, Insurance, HMO problems

Questions Answered By Expert John Pedit
In Category Medicare, Medicaid, Insurance, HMO problems

Subject	Date Asked

Medicare and Cobra	11/20/2009
Q: I have cobra (my husband was fired from his job), in dec. I will have medicare and I am on ... A: If it is not medically necessary, neither will pay. If the doctor says it is medically ...
Private Insurance and Medicade	11/19/2009
Q: I will turn 65 in 4 months and need to decide whether to keep two private insurance policies that ... A: This is way too complicated to be done by e-mail, so I am going to refer you to my counterpart in ...
Medicare Complete	11/19/2009
Q: My parents live in northern Ohio and currently have AARP/MedicareComplete from Secure Horizons, Plan ... A: You could not have asked at a better time. The open enrollment period is now until New Years eve. ...
Freedom Health	11/18/2009
Q: I have a friend who recently took a job with Freedom Health and is encouraging me to apply. I do not ... A: Look at the back cover of the MEDICARE AND YOU 2010 that you just received and there will be a ...
Problem with Medicare/Medicaid billing	11/17/2009
Q: My husband is on Medicare plus a Medicare Advantage Plan (Evercare). He was recently approved for ... A: It appears that there has to be an appeal made. Also since you are a dual eligible and should be ...
Expedited Medicaid---Full Medicaid	11/16/2009
Q: I was approved for expedited medicaid last month (October 6) and have submitted all necessary ... A: The regulations are different in each State, so, I am going to refer you to my counterpart in Ohio. ...
medicaid vs medicare	11/14/2009
Q: I have been on disability for 2 years and have carried my own insurance policy 2 months ago I ... A: Boy, are you miss informed. You are a dual eligible, having Medicare and Medicaid. This makes you ...
Re: The Plan wording	11/14/2009
Q: You said to read my current UHC plan carefully and the following paragraph have me confused as to ... A: You are getting there. Let us add a little safety to this. Have my counterpart in your area double ...
Re: The Plan wording	11/14/2009
Q: You said to read my current UHC plan carefully and the following paragraph have me confused as to ... A: single and not working or married and neither working Medicare is primary, employer plan 2nd ...
Re: The Plan wording	11/14/2009
Q: You said to read my current UHC plan carefully and the following paragraph have me confused as to ... A: That would confuse anyone. Working person: plan first====Medicare 2nd spouse plan ...
Medicare part B	11/13/2009
Q: just because you are 65 years old, do you have to enroll in Medicare part B? EGHP is in place 100% ... A: You just received a copy of Medicare and You 2010 in the mail from Medicare. The information is in ...
Approved for SSDI does existing PPO insurance remain my primary and Medicare A & B secondary ins	11/11/2009
Q: I recently was approved for SSDI benefits retroactive to March 2007. I have been insured with a ... A: As long asyou are on his plan and he is still working, his plan is primary and you do not need part ...
Medicare Plan B RETRO	11/10/2009
Q: I was misled when I was "offered" medicare plan B when i went into kidney failure. I now am being ... A: There is a lot of missing information in the question, and it is too complicated to be done by ...
Ret policy/COBRA	11/5/2009
Q: A Wife that has BCBS COBRA through her employer who is covered under her husbands retired group ... A: In this case COBRA would be her primary. However, check to see if they got letters from their ...
Ret policy/COBRA	11/5/2009
Q: A Wife that has BCBS COBRA through her employer who is covered under her husbands retired group ... A: Medicare is primary. However, there are missing factors in the question. Does she have Medicare ...
Medicaid query	11/3/2009
Q: My mother has been unable to work for years because of a long-time back problem that's gotten worse ... A: SSI: Go to the local Social Security Office and get a copy of the SSI manual. Also get a copy of ...
healthcare	11/3/2009
Q: mom is 85y/o with dementia. living with me. she moved here 1 year ago,becouse of circumstanses. she ... A: This is too complicated to be done by E-mail. Therefore I am referring you to my counterpart in ...
Medicaid	11/2/2009
Q: My daughter a medicaid receipant was in Missouri for vacation when she became ill and had to go to ... A: That is the problem with Medicaid. Each State is a separate identity and have their own ...
Non-medicare provider	10/30/2009
Q: Recently my wife chose to work with a psychologist who does not accept payment from third parties. ... A: I am not a lawyer and this is bordering more of a legal question than a Medicare question. A ...
Medicare Part D	10/29/2009
Q: I recently joined medicare & need to find a good reliable provider for part D, any recommendations ? ... A: Prepare a list of all your prescriptions, how often you take them, and the dosage. Then: A. Go to ...
BCBC, Medicare A, VA health care	10/26/2009
Q: After years with BCBS FEP and Medicare Part A, I pretty much have a handle on how they work ... A: I have Medicare and Tricare for Life, so I have not kept up with the VA benefits. You did not ...
Medicare Special Enrollment Period	10/26/2009
Q: I did not sign up for Medicare Part B when I turned 65 because I was (am) covered by my spouse's ... A: Not by quoting a specific law. However go to Medicare Interactive.org===keyword Part b ...
Medicare Special Enrollment Period	10/26/2009
Q: I did not sign up for Medicare Part B when I turned 65 because I was (am) covered by my spouse's ... A: Hard to understand. Two entirely different law codes are involved, Medicare and COBRA. In this ...
settlement	10/26/2009
Q: My mother received a large money settlement in one lump sum and is on disablilty, medicare, and ... A: The Medicaid regulations are different in each State. Because of that I am referring you to the ...
Transfer of Medicaid Between States	10/23/2009
Q: You responded to a question about transferring a nursing home resident from Oregon to Washington by ... A: It all involves Medicaid. Approximately half of the money for Medicaid is Federal and the rest from ...
Medicaid/Estate Recovery	10/22/2009
Q: We live in PA and we have been caring for an uncle who has no other surviving relatives (it was only ... A: This is too complicated to be done bt e-mail, and I am in the wrong State. So I am going to refer ...
Medicare HMO state transfer	10/20/2009
Q: My father is going on day 64 in the hospital after a post-operative perforated bowel which led to ... A: Too complicated to be done by e-mail. So, I am referring you to my counterpart in PA. Call ...
Help please	10/16/2009
Q: I am upset. While visiting my family in CA, I took my 5yr old triplets to the ER for upper resp. ... A: Because State money is used for approximately half of the Medicare funds in each State, the ...
MSP coverage	10/15/2009
Q: I take care of my brother who is disabled and I claim him on my taxes as a dependant. Right now, he ... A: Your way may work out, but there may be a better way. I am referring you to our program(SHIP} in ...
Would I qualify, if so for bariatric surgery in FL?	10/14/2009
Q: I've read through what I could understand of floridas medicare website/s. I can't seem to figure out ... A: Go to the State web site=====keyword and click on MEDICAID=====find and scroll on Programs. Also go ...
Would I qualify, if so for bariatric surgery in FL?	10/14/2009
Q: I've read through what I could understand of floridas medicare website/s. I can't seem to figure out ... A: The person to ask is the doctor. He is the one that assigns the claim payment code. If he says it ...
Medicare	10/9/2009
Q: My parents currently have MedicareComplete H0543 - 084, an HMO plan. My Mom was diagnosed with gall ... A: The trouble with an HMO, you have to get permission to go out of network. Without that you have to ...
post op co payments	10/6/2009
Q: I am 78 years (diabetic) old and I am having cataracts removed. The surgeon recommended that I have ... A: The question is when you were told they were not covered. With Medicare the doctor is required to ...
Medicare & HSAs	10/6/2009
Q: She was told when she called that she must sign up for Part A. In doing so, she is no longer ... A: Since Medicare would not be primary, it is kind of unusual for her having part A effecting your ...
post op co payments	10/6/2009
Q: I am 78 years (diabetic) old and I am having cataracts removed. The surgeon recommended that I have ... A: Those Advantage plans look good and cheaper than original Medicare. They are if you are in good ...
How to appeal an elderly parents release from a hospital?	10/2/2009
Q: My dad is in a hospital in a small town. He will be out of Medicare days tomorrow and the hospital ... A: The hospital is required to issue a packet of instructions to the patient when they are admitted to ...
Transferring Medicaid between states	9/29/2009
Q: I have a child who has been placed by the court system in residential facility in SC fro a crime he ... A: In essence he would be moving from one State to another. Since each State has it's own Medicaid ...
Medicaid	9/26/2009
Q: I am a disabled for 10 yrs man due to mental and 4 failed back sugeries i have 2 steel hips. I have ... A: This is too complicated to be done by e-mail, so I am referring you to my counterpart in SC; Call ...
difference in plans	9/23/2009
Q: I have had a MedicareComplete plan from Secure Horizons for 3 years. I recall that when I initially ... A: Kind of a bad time to ask these questions, but, a good time because the open enrollment periods are ...
Medicare Part B Coverage	9/23/2009
Q: Do you know if Medicare Part B covers treatment for Age Related Macular Degeneration. I have not ... A: It is covered. Whenever you have a question on coverage, ask the provider. With Medicare, they ...
Medicaid approval	9/20/2009
Q: My father-in-law was admitted into the hospital last week and has been diagnosed with a debilitating ... A: This is far too complicated to be done by e-mail, so I am referring you to my counterpart in NY, ...
Provider not enrolled in Medicare	9/15/2009
Q: I have several providers who are not enrolled with Medicare, Medicare does not recognize the ... A: I do not get too involved in provider problems. But, if they want to get back covering Medicare ...
medical insurance for 23 yr old daughter	9/15/2009
Q: My daughter developed a pulmonary embolism at the end of june 2009 . She was 3 weeks in the hospital ... A: This is really outside of my expertise, however maybe this might help. Go to benefits.com===enter ...
Elderly parents and Medicare/BlueCross	9/11/2009
Q: My father has both BCBS Federal Employee Program health insurance and Medicare Hospital ... A: I still will not be of much help. That confusion arises because the attending doctor may want a ...
Elderly parents and Medicare/BlueCross	9/11/2009
Q: My father has both BCBS Federal Employee Program health insurance and Medicare Hospital ... A: You don't ask easy ones, do you. I do not know: A, If he opted out for the Federal program or ...
Transferring Medicaid.	9/9/2009
Q: I just recently moved to Florida from New York, I have New York Medicaid, How to I go about ... A: Each State has it's own rules and regulations regarding Medicaid, and they are not compatible with ...
surgery coverage under medicare	9/9/2009
Q: Is it true that a patient over the age of 80 would not be covered for hip replacement surgery under ... A: That is an easy excuse for not covering something. If the doctor says it is medically necessary and ...
MVAs and Medicare	9/8/2009
Q: I practice medicine in Florida where there is mandatory PIP insurance for MVAs. I have occasion to ... A: Medicare is not the primary, the liability insurance is. Medicare will not pay until after the ...
medicare	9/8/2009
Q: I wish to cancel Medicare, Plans B, C, and D. I wish to only retain Plan A. How do I do this? A: Part B: go to the local Social Security office and disenroll. C and D, send them a letter ...
medicare coverage	9/2/2009
Q: My mother (82) in otherwise good heath has just learned she has uterine cancer.My preference for her ... A: Not enough information. If she has original Medicare with a Medigap policy, there should be very ...
Medicare while your working	9/2/2009
Q: I am 65 (last April), I am working full time. I am paying $45.oo a week out of my paycheck for ... A: You need to do two things: Call the Coordination of Benefits(COB) at 1-800-999-1118 and make sure ...
response to missing info	8/31/2009
Q: I had physical therapy (PT) services 2 years ago in Florida. I was referred properly. I have ... A: Jim I am not a lawyer and can not give you legal advice. The path to a claims expert that I gave ...
response to missing info	8/31/2009
Q: I had physical therapy (PT) services 2 years ago in Florida. I was referred properly. I have ... A: Call 1-800-Medicare. When it opens up, you will be in the auto section so immediately say AGENT. ...
Humana Gold Plus HMO	8/30/2009
Q: I am a mental health provider in Louisiana with a provider contract with Humana and Corphealth, ... A: As usual, there are no hard and fast lines as to who is responsible for claim payment. The provider ...
Medicare/no fault auto insurance	8/30/2009
Q: I fell and broke my wrist, I went to the hospital, then was referred to a Clinic, where I saw 2 ... A: This is really a legal question and outside of my expertise. BUT, maybe this might work for you. ...
Humana Gold Plus HMO	8/30/2009
Q: I am a mental health provider in Louisiana with a provider contract with Humana and Corphealth, ... A: This is really outside of my expertise, since the regulations are different than in Louisiana than ...
Relocation from NY to MA	8/30/2009
Q: My girlfriend's mother is 86 years old, covered by Medicare and currently suffers from Parkinson's ... A: She would have no problem with basic Medicare except to get new doctors. Depends on her ...
Blue Cross Senior Blue HMO	8/29/2009
Q: Is Senior Blue a Medicare Suppliment or a Medicare Replacement? Can you more? Can you explain the ... A: Medicare has deductibles and co-pays. Original Medicare set up a program whereby Medigap plans ...
Shingle scars	8/28/2009
Q: I have had two outbreaks of shingles in the last six years. The first outbreak went into a ... A: It is a question of whether it is medically necessary. The provider is the one that decides which ...
medicare lien	8/27/2009
Q: I have been attempting to research a property I am interested in buying, but am having extreme ... A: This is really outside of my expertise. However I may have some useful information. There is a ...
Medicare & private insurance	8/26/2009
Q: My friend is currently on Medicare A & B due to disability. He is under the age of 65. He will be ... A: Unless he or his spouse is working and he is on the spouse's plan, Medicare will remain primary. ...
disability medicare supplement	8/25/2009
Q: I am disabled with a back injury and have been on disability medicare for five years. I have tried ... A: This is too complicated to be done by e-mail. I usually spend about an hour in a counseling session ...
Medicaid then Medicare	8/24/2009
Q: John, Approx. 18 months ago, while enduring the Medicare denial process I qualified for and receive ... A: This is far too complicated to be done by e-mail. I usually take over an hour when I counsel ...
Employer paying for a Medicare Supplement Policy	8/22/2009
Q: I have an employer that wants to pay for a Medicare Supplement policy for an active employee. The ... A: In 17 years I have never heard anything like that explanation of who can pay. I think they are ...
hospital charity	8/20/2009
Q: My husband and I have some very large medical bills and no insurance. We were told by someone that ... A: Yes that quota system exists. Check with the Medicaid office and see if you can use those old ...
Inheritance/Medicaid/Medicare	8/19/2009
Q: I am a 45 year old male with renal failure, have had two failed kidney transplants and have been on ... A: Each State has their own regulations for Medicaid and also for the State Recovery Act. Because I ...
Medicaid	8/17/2009
Q: My father has no insurance and rarely sees a doctor, unless he's at his witt's end and can't avoid ... A: Basically not true and very unlikely to happen. But there are some other issues to consider and ...
Medication costs with Medicare and Suplimental insurance	8/16/2009
Q: I'm not quite sure if this is the right category or not. I'm really kind of over a barrel. My ... A: Pretty complicated to be done by e-mail. So I am going to refer you to my counterpart in your ...
Medicare Part B	8/13/2009
Q: John, I am under 60 and retired. My retirement was a normal retirement after 30 years. After ... A: Medicare does not squeal on you. since you are retired, Medicare becomes your primary insurance ...
Medicare	8/12/2009
Q: This is a question about billing a patient if the provider they are seeing is not a provider with ... A: The patient can not play it both ways. Since the provider does not accept Medicare, they do not ...
Medicare coverd procedure	8/12/2009
Q: Will Medicare cover the lap band procedure for weight loss? I have high blood pressure and ... A: The determine factor: Is it medically necessary. That decision rests with the doctor. He is the ...
PPO and Medicaid	8/8/2009
Q: I am a remarried mother of 3 minor children in Louisiana. My family has wonderful PPO coverage ... A: I think you have just about answered your own question,,Since you like the system without having ...
Secondary Payments after Medicare	8/3/2009
Q: I am being told that the 20% coinsurance must be pif by the secondary payer or applied to the pt ... A: Hard to answer because you did not explain what the secondary policy was..So one of these three will ...
medicare supplemental insurance	8/2/2009
Q: I worked for a company for 25 years. I had to go on disability.I have permanent work restrictions. I ... A: Impossible to be done by e-mail. A lot depends on the laws of the State you are in. If your State ...
Medicare	7/30/2009
Q: I have a family member who has a question about Medicare Presciption Plan Part D. She is going to ... A: Number is 1-800-443-9854. Give them a call and request to speak to a counselor Reason I say this ...
Questions about Medicare Advantage Plans	7/29/2009
Q: I am enrolled in Original Medicare so I have first hand experience with how that plan works. I have ... A: As you can see, original Medicare with a Medigap such as plan C covers just about everything wither ...
Medicare Eligibility	7/27/2009
Q: I am turning 65 in October of this year and I am still working and will continue to work full time ... A: Go to the local Social Security Office and get a copy of MEDICARE AND YOU 2009. It will give you a ...
PA Medicaid Estate Recovery Program	7/26/2009
Q: My dad passed Aug. 08. There were no assets, no will, no property. All he did have was a 5,000 life ... A: Under the circumstances,I doubt it. However not only are the Medicaid regulations in each State ...
Medicaid QMB	7/24/2009
Q: Does Medicaid QMB cover expenses that Medicare does not such as tub seats and ambulette ... A: QMB is not a Medicaid function, it is a Medicare Savings Program.. Confusing because it is usually ...
connecticut Medicaid	7/23/2009
Q: I receive SSI and medicaid. My pain management doctor will no longer be accepting medicaid. I want ... A: Basically what you would be doing is a private contract with the doctor. You pay. To check things ...
acquiring medicaid benefits in a new state	7/17/2009
Q: My brother-in-law is a 55 yr. old man with Down's Syndrome. He has been residing in a group home ... A: The Medicaid program is run by the State the person is in and therefore each State has some ...
medicaid and medicare	7/16/2009
Q: I live in North Carolina,but want to move to Virginia. I have medicaid and medicare. Will I need to ... A: Medicaid: Because each state has it's own program you will have to drop it in NC and reapply in ...
Medigap Coverage	7/13/2009
Q: We are considering medigap coverage. I split my time between our primary residence in California ... A: Sure will. That is the advantage of the gaps. However, If you have a Blue Cross Plan, and the ...
cancelling wellcare	7/11/2009
Q: my parents want to cancel wellcare how can i assist them in doing so? they are presently on medicare ... A: Since the door to door was not legal, there should be no problem Look on the middle of the back ...
Cobra to SSD	7/1/2009
Q: again John. I have followed all your advice so far. My husband chose only Part A and went on his ... A: By all means apply for SSD. But now it becomes difficult to advise. You are pretty well set up as ...
Age 65, Still Working SS and Medicare question	6/25/2009
Q: My mom turns 65 this year and still wants to work. She has Health Insurance at her job. She is ... A: She sure can Go to the SSA office a couple of months before her birthday and apply for Medicare. ...
elderly patient, broken hip	6/24/2009
Q: Before falling at the end of April and breaking a leg just below the hip joint, my 90-year-old ... A: Locate the Area Agency on Aging that covers your area. They have many programs and services that ...
reply to your questions	6/22/2009
Q: John, I asked my original question a few days ago and you replied with a list of questions. I sent ... A: Been running between doctors for the last two days. Still a little shaky. For Him: he will have ...
Medicare coverage	6/22/2009
Q: I am 67& receive SS and medicare A & B benefits as primary and personal insurance as secondary ... A: With Medicare it is pretty limited. From US mainland: emergency when traveling in a direct course ...
Cobra/Medicare/leave of absence	6/20/2009
Q: John: I wrote to you last year but my situation has recently changed. I am on medical leave from ... A: Boy, you do not ask easy ones. Off hand it would appear that I would recommend both going on his ...
Transferring state to state	6/18/2009
Q: I am moving to texas and wondering if I can transfer my medicaid down there and how i go about doing ... A: Because each State receives federal money for part of their Program and uses State money for it, ...
Medicaid and Inheritance	6/16/2009
Q: My sister is disabled and has been on Medicaid for many years. She is due to receive an inheritance ... A: Ohio has one of the best systems in the US. So check with the case worker. The accountable assets ...
transferring Medicaid	6/16/2009
Q: I have a friend at church who has decided to move to Kentucky from Indiana and has asked me what ... A: Each State has separate funding and regulations. so basically you can not transfer Medicaid from ...
Medicaid and Inheritance	6/16/2009
Q: My sister is disabled and has been on Medicaid for many years. She is due to receive an inheritance ... A: Hard to answer because the Medicaid and the Recovery regulations vary from State to State. However: ...
Do I submit Medicare balances to Medicaid?	6/13/2009
Q: I am totally new to all of this. My brother 42 suffered a massive stroke. He has NJ Medicare Part A ... A: The Medicaid regulations and procedures vary from State to State and I am in Michigan. You can talk ...
Recast therapy	6/12/2009
Q: My doctor wants me to take the Recast osteoporosis therapy. It is an outpatient treatment given by ... A: Sorry I do not know the answer, it is outside of my expertise. However, unlike commercial insurance ...
How to work around signing a medicare opt-out?? HELP!	6/9/2009
Q: I just asked this question of another expert, but wanted to get your take on it as well: I'm a ... A: Too complicated to be done by e-mail. PROVIDER WITH MEDICARE CONTRACT: Must bill Medicare ...
How to work around signing a medicare opt-out?? HELP!	6/9/2009
Q: I just asked this question of another expert, but wanted to get your take on it as well: I'm a ... A: There are too many unanswered questions for a good answer. Also I would like to look at what the ...
Medicare paid for services then denied paying for the same ones.	6/8/2009
Q: I went to a Chiropractor off and on since 2004 I never received any type of bills from them for any ... A: Sorry they just changed the page and it is now harder to find. Go to medicare.gov/contacts===click ...
medicare payment for oxygen supplies	6/7/2009
Q: Can you please explain to me why, when my father lived at home, all of his oxygen supplies were paid ... A: This is a little hard to do by e-mail since there is several factors involved. Basically oxygen is ...
denied cancer claim	6/6/2009
Q: my wife has stage 4 pancreatic cancer, she has been receiving chemo treatments for 6 years now . on ... A: This needs someone to sit down with you and help you form an appeal. Therefore I am referring you ...
Medicare paid for services then denied paying for the same ones.	6/5/2009
Q: I went to a Chiropractor off and on since 2004 I never received any type of bills from them for any ... A: This is far too complicated to be done by e-mail. Therefore I am referring you to my counterpart in ...
Medicare Part A	6/5/2009
Q: I'm 66, full-time worker w/full medical coverage. If I don't enroll in Part A now- and am laid off- ... A: It is free so why not get it. It will save time and effort when you leave your employment. Your ...
medicare, kaiser permanente small business	6/4/2009
Q: I was wondering if you have an insurance company supplementing Medicare, will that insurance company ... A: For something like this you would need to sit down with a counselor and go through the bills and so ...
SSI was taken after 35 years	6/2/2009
Q: I have crones disease for over 35 years. I have had disability for that long. Recently got a 23.00 ... A: Go to Medicare.gov====scroll down to How to find a SHIP Counselor in your area=====enter your ...
Full time employee over 65	6/2/2009
Q: My Company employs less than 20 people. We have Tufts HMO, and switching to 1st Health Network. I ... A: Basically Medicare is primary and you need Part B or any employer program will not pay. However, ...
Medicare supplemental insurance	5/19/2009
Q: Can a disabled person at age 53 yrs drawing Medicare get supplemental insurance to cover the other ... A: They can in Michigan and many other States. Several of the States make it mandatory for insurers to ...
hospital bill	5/16/2009
Q: My wife was admitted to a hospital for kidney stones in 2007. One of the doctors did not submit his ... A: If this is not a Medicare question, it is out of my area of expertise. If a doctor accepts ...
AARP Medicare Complete through Secure Horizons	5/14/2009
Q: Is there any way to cancel membership in this plan if it was misrepresented by agent? This plan is ... A: If it was misrepresented by an agent you can do so. You can call 1-800-medicare===as soon as you ...
Signing Up Still Working	5/6/2009
Q: I will be 68 this year but plan to work for 4 more years. I have health insurance through my ... A: You have a good friend. Go to the local Social Security Office and get a copy of Medicare and You ...
Medicare	5/4/2009
Q: My aunt was on short term disability,her husband was on Medicare. She then went to long term and was ... A: Not enough information. Depends on whether or not you were a working spouse. If you were still ...
Laid off by my employer-how do I get my husband on Medicare?	5/3/2009
Q: Firstly, thank you John for your kind help and assistance to all of us. In these tumultuous times, ... A: WOW. AM i GLAD YOU GOT BACK TO ME. I had two cases come up within 10 minutes of each other with ...
Qualifying for Medicare	5/2/2009
Q: Seven years ago I qualified for Disability, but didn't take it at that time as I was receiving ... A: It all boils down to getting Social Security disability. Once you have that the disability checks ...
Laid off by my employer-how do I get my husband on Medicare?	5/2/2009
Q: Firstly, thank you John for your kind help and assistance to all of us. In these tumultuous times, ... A: You are right about the subsidy. He does not have much choice other than to get and keep on COBRA ...
Qualifying for Medicare	5/1/2009
Q: Seven years ago I qualified for Disability, but didn't take it at that time as I was receiving ... A: You passed up a golden opportunity by not getting the disability payments started. You would have ...
Medicare	5/1/2009
Q: program......sure seems confusing to try to decide which might be the best....i can afford up to ... A: I usually take about an hour when I counsel someone on this. So I am going to refer you to the ...
qmb	5/1/2009
Q: my mom is currently on medicare and qmb in texas.she inherited 100,000.i have advised her she now ... A: This is too complicated to be done by e-mail. ASAP call 1-800-252-9240 and request to speak with a ...
medicare	4/30/2009
Q: I have medicare as a secondary and the er doc sent me to collections before medicare has made ... A: The collection agencies are a real pain. You should ask the doctor to call off the collection ...
BXBS Medicare Plus Blue (Michigan)	4/26/2009
Q: My husband had surgery back in Dec.08. The insurance paid the doctor & his assistant, inpatient ... A: OK. Call 1-800-802-7174 and ask for a MMAP counselor. Tell the counselor John Pedit referred you to ...
BXBS Medicare Plus Blue (Michigan)	4/24/2009
Q: My husband had surgery back in Dec.08. The insurance paid the doctor & his assistant, inpatient ... A: You really should meet with one of our counselors. What city or county are you located in. A lot ...
HMO referrals	4/22/2009
Q: I am a relatively new biller for a rheumatologist in Brighton, MI. One of my responsibilities is to ... A: A little out of my line. However, you can get a list of insurances from the State Insurance Bureau. ...
medicare and private insurance	4/19/2009
Q: In June I will go on medicare. Should I get Part B since I have private insurance? I am retired, ... A: When you go on Medicare, Medicare will become your primary insurance. Thus you will need Part B. An ...
/SSI/Medicaid and SS Disability Income	4/17/2009
Q: My brother-in-law had a severe case of encephalitis in Oct/2008 went to the hospital several times ... A: This is too long and complicated to be done by e-mail. Call the SHIP program at 1-800-963-5337 and ...
patient responsibilty	4/16/2009
Q: Patient was seen by Dr. billed medicare for office visit along w/ refraction charge...no secondary ... A: Most of the information that you are looking for should be on the Summary Notice that the patient ...
Medicare questions	4/11/2009
Q: My sister is 47 years old and is no longer able to work because of stage IV lung cancer. Can we get ... A: Not by SSI. Yes with disability, however there is a 24 month waiting period after the disability ...
Dementia & Home Care	4/3/2009
Q: My husband has been diagnosed with dementia which resulted from a head injury & craniotomy 4 years ... A: Check with the doctor about any possibility for a home health program. The doctor is the one that ...
Death Benefits!	3/31/2009
Q: My father is getting both medicaid and Medicare benefits. My question is do these benefits also ... A: Because the Medicaid regulations are different in each State, that is hard to answer. Funeral ...
bigzac69@yahoo.com	3/25/2009
Q: I have a rotator cuff damage which cannot be repair according to Doctors at the Sports Medicine ... A: The doctors are the ones that assign the Medicare payment codes. They are the ones that determine ...
How do you obtain a case worker for Medicare?	3/24/2009
Q: I'm trying to obtain a breath pacemaker implant in Cleveland, OH. I am quadriplegic and currently ... A: There is something wrong with this question. There is no such thing as a case worker if you are in ...
Medicare MSP Rules	3/24/2009
Q: A followup to your answer to Theresa on 11/19/2008 on Medicare MSP Rules for disabled individuals. ... A: since neither you or your spouse are "Working",Medicare is primary. Your coverage is ...
Should I sign up for Medicare Part B?	3/20/2009
Q: I am a retired Federal employee. I have Federal Blue Cross Standard option with mail order pharmacy ... A: Kind of surprised. My son and one of my nieces are in Alaska and had no trouble finding Medicare ...
signing up for Medicare part B after living in Canada	3/18/2009
Q: My friend has an elderly mother who lives in a nursing home in Canada. The mother worked in the ... A: They will not sign her up for Pat B until she relocates to Oregon. Then the signing up for Part B ...
Medigap vs Employer secondary insurance	3/15/2009
Q: I need your help badly! Am on a tight deadline. I live in Virginia and have already signed up for ... A: This is too complicated to be done by e-mail. I usually spend an hour on it when talking with ...
Medicare with private insurance	3/13/2009
Q: Can a person qualify for Medicare (or parts of Medicare) if they also have private insurance without ... A: In most cases people eligible for Medicare have both Medicare and a supplemental policy. You really ...
breast reconstruction	3/13/2009
Q: Medicare is my only insurance. I lost my right breast due to breast cancer. Will medicare cover ... A: Just ask the doctor. The provider is the one that decides if something is medically necessary and ...
Son without a doctor	3/10/2009
Q: My son is 22. He is disabled. He has the following insurance policies: PPO,(Primary) Medicare ... A: This is too complicated to be done by e-mail, so I am referring you to the Medicare SHIP program. ...
Medicaid/Medicare	3/9/2009
Q: Help! I am disabled with COPD,I am 53 I've been getting ssdi for almost 2 yrs.I also get ... A: This is too complicated to be done by e-mail, so I am referring you to the Medicare SHIP counseling ...
Health Insurance quandry	3/8/2009
Q: I have a son who is 23 years old. He has been in Renal Failure since birth, He has been on dialysis ... A: This is really a little too complicated to be done by e-mail. Therefore I am referring you to the ...
premisce medicare	3/6/2009
Q: JOHN PEDIT. MY NAME IS MELODY KEELING AND I 'M HAVING PROBLEMS CONTACTING YOUR OFFICE ABOUT THIS ... A: This is too complicated to be done by e-mail. So, I am referring you to the nearest SHIP office, ...
Retired mom on GHI from deceased husband's pension	3/6/2009
Q: My mom who is 71 receives a federal pension from my dad who passed away. Part of the pension benefit ... A: This is far to complicated to be done by e-mail. So, I am referring you to the nearest SHIP ...
Medicare as secondary questions	3/5/2009
Q: Disabled in 2000 from vehicle accident. Wife has job and we have a BCBS of TX PPO policy that ... A: Because Medicare has a deductible for both A and b, it is very unlikely that any of your employer ...
PPO as secondary to Medicare	3/2/2009
Q: If a person has Medicare parts A&B, is there a PPO that will serve as a secondary whose rates are ... A: Good news, answer is yes, yes, yes, Not only that, but I am guessing that the BC in your State has ...
Requirements for Medicaid	3/1/2009
Q: My father-in-law is nursing home bound. He receives his monthly SS check as well as a pension from ... A: Medicaid regulations vary since each State has their own regulations. However the basic concepts are ...
Medicare	2/25/2009
Q: My husband is about to retire after 30 years at a coal mine. We live in Pennsylvania and he has UMW ... A: There is way too much information for this to be done by e-mail. Go to the local Social security ...
brother having trouble with initial medicare coverage	2/24/2009
Q: My brother is/was covered by the North Carolina State Health plan. He was in his last semester of ... A: It appears that the Coordination of Benefits(COB) does not have the correct information on file. ...
Wellcare & Medicare	2/23/2009
Q: My father-in-law signed up for Wellcare a year ago when a solicitor came to his home. Since then, ... A: This is way to complicated to be done by e-mail. Someone needs to sit down with you and review the ...
health insurance benefits through my employer	2/23/2009
Q: When I apply for Medicare because I am reaching 65, will it affect my health insurance benefits ... A: When you go to the Social Security office a couple of months before applying for Medicare, pick up a ...
HMO and Medicare payments to doctors	2/22/2009
Q: I've never quite understood how doctors are paid under such programs. Does the doctor you select ... A: Under original Medicare the doctor get paid a given amount for a code number. He bills ...
Cancel Medicare HMO	2/20/2009
Q: I am disabled and in need of surgery. I have a Medicare advantage plan and I am on state run ... A: There is not enough information to give a good answer. Also I am in Michigan and am not familiar ...
Quick Question	2/10/2009
Q: My Father of 86 has recently decidied to be a part of a "Home Hospice" program. He has been on this ... A: I am in Mi, so I am not familiar with the NV agencies. I recommend you call 1-800-307-4444 and ...
Moving states	2/8/2009
Q: I am currently 13 weeks pregnant and I live in Georgia. I am on the medicaid program for pregnant ... A: Each State has their own Medicaid program,so they are not transferred from one State to another. ...
Hysterectomy coverage	2/3/2009
Q: My husband and I are missionaries in India.Our USA home is in Michigan. I need to have a ... A: That is a tough question. Part A cost would be $1,068. That is the easy part. The hard part is ...
Medicare rules	2/2/2009
Q: If a patient has a Medicare replacement (HMO) plan, and when I verify the insurance, they tell me ... A: There are two methods of payment for Medicare. Original Medicare with a Medigap plan, OR a ...
Hysterectomy coverage	2/1/2009
Q: My husband and I are missionaries in India.Our USA home is in Michigan. I need to have a ... A: Sorry, but it will not be covered by Medicare outside of the US. Coverage outside the US is done by ...
Medicare supplemental health question	1/28/2009
Q: My mom is having difficulty with BCBS supplemental health insurance. She is getting no answers from ... A: That makes it tough. Call 1-800-552-3408. It is the number for the Medicare SHIP counseling program ...
Balance Billing:	1/25/2009
Q: My mother is insured with a Medicare PPO in Nevada. While visiting family here in Northern Virginia, ... A: Remind the provider that they DO HAVE a contract with Medicare. since they have received all that ...
Medical Billing	1/21/2009
Q: Is it legal to bill different insurances different amounts for the same procedure? CPT 99213 (E&M ... A: They sure do differ. It depends on the negotiated price agreed upon between the insurance plans and ...
Medical Billing	1/20/2009
Q: Is it legal to bill different insurances different amounts for the same procedure? CPT 99213 (E&M ... A: That sort of thing happens all the time, and is based on who pays first, what % they pay. if covered ...
Dads medical Insurance	1/15/2009
Q: My dad recently went on disability and his employer is wanting to cancel his medical insurance he ... A: You are talking about commercial insurance coverage, and there are thousands of variations of ...
Medicare	1/14/2009
Q: My Dad just got laid off last week from his job and my parents' are covered under the company's ... A: Go to the local Social Security office and get a copy of Medicare and You 2009. It will answer most ...
Birthday rules	1/12/2009
Q: My wife and I both have family coverage from our employers. The cost of her family is so high that ... A: If either of you are on Medicare disregard this answer. I have never heard of this birthday thing. ...
Obtaining Medicare denials for secondary insurance	1/9/2009
Q: Pedit, Would you happen to know how non-participating providers obtain denials from Medicare so we ... A: If the patient has Medicare and has a Medigap supplemental, and the provider does not accept ...
medicare coverage	1/9/2009
Q: I am asking the following question on the behalf of my mother in law. Can medicare or medicaid help ... A: The regulations are different for Medicaid in each State, and I am in Michigan. Go to ...
Medicaid/Nursing Home	1/7/2009
Q: I am the granddaughter of a nursing home resident in Macomb County, Michigan. My grandmother lived ... A: Call 1-800-803-7174, and you will get the nearest office of the Medicare,Medicaid Assistance ...
Disability / Social Security	1/3/2009
Q: I am 62+ and could draw social security, but I am trying to work for benefits. I have a great deal ... A: Go to benefits.com and enter the information they request. They will screen about 400 different ...
when do I apply?	1/1/2009
Q: I will be eligible for medicare in June,2009. When do I sign up for my substidy insurance? A: If you are already receiving Social Security you will automatically receive your card about 2 months ...
Medicare or husband's work insurance primary?	12/30/2008
Q: I live in WI & am eligible for Medicare A & B thru disability but chose not to take B because I am ... A: What we have is an intermingling of various laws. As of now by law,since you are on your working ...
medicare & blue cross	12/29/2008
Q: I just received a letter from Blue cross that as of Feb 09 I will not be covered any longer under ... A: Giving up Medicare will cause problems later on and will probably bring on some premium venalities. ...
What does Medicare B cover that the primary doesn't	12/29/2008
Q: My wife is eligible for Medicare for a disability in February of 09. I currently have PPO coverage ... A: You have too many questions for this to be done by e-mail. Normally I would spend about 45 minutes ...
Secondary insaurance for younger poor Disabled	12/27/2008
Q: secondary Medicaid. I have a spend in of $50.00 per month medicaid If I'm hospitalized I need to ... A: You really need to talk with a SHIP counselor ASAP. Go to Medicare.gov===there will be a menu on ...
What does Medicare B cover that the primary doesn't	12/26/2008
Q: My wife is eligible for Medicare for a disability in February of 09. I currently have PPO coverage ... A: As long as she is on your plan and you are still working, your plan is primary and Medicare is 2nd ...
Supplemental insurance & Medicaid	12/21/2008
Q: is a supplemental insurance policy necessary when a person has Medicare & Medicaid? This person ... A: Medicaid is paid for by both Federal money and state money. Approximately half and half. And it is ...
Problem with Pre-authorization	12/18/2008
Q: Last month I had a myomectomy, an absolutely necessary procedures. My doctor's office called for ... A: If you are in original Medicare, turn the Summary Notice over and follow the instructions on how to ...
Phony medical bills.	12/17/2008
Q: I had a stress test and office visit with a cardiologist. The bill was $3,041.63. Since I am on ... A: Confusing it is. When a doctor sends in a claim he uses the normal charge for that procedure in the ...
penile prosthesis surgery	12/15/2008
Q: I have a question about penile prosthesis surgery under medicare. My Medicare coverage (part A) will ... A: Medicare pays it's portion when it is medically necessary. So ask the doctor. He is the one that ...
Medicare Advantage and HMO	12/15/2008
Q: What is the difference between Medicare Advantage Plans and HMO plans? A: Hy Joy There is no difference, Managed care plans are grouped together and are called Advantage ...
Medicare cover TMJ Total Joint Replacements	12/12/2008
Q: I have had TMJ for many years and ended up with Bilateral TMJ Bony Ankylosis. I had to have ... A: As long as the doctor says they are medically necessary they will be covered. About 6 months before ...
Medicare+Medicaid	12/11/2008
Q: My mother was in hospital for 10 days. She was seen by hematologist. We didn't ask for this Dr. ... A: Call the office of the provider and explain the situation and see if they will waiver the 20%. If ...
Medicaid Paid - Retroactive Medicare Elig	12/10/2008
Q: You previously answered a question regarding Tricare and Medicare Retroactive coverage. In a ... A: That is my understanding, but this is not a legal opinion. It is dependent on the Medicaid ...
mediciad and other supplemental insurance	12/9/2008
Q: My Mother in Law has qualified for Medicaid. Is there any reason to keep her BCBS supplemental ... A: Usually not. However, because Medicaid regulations vary from State to State, it is possible the ...
Does Medicare cover a hernia operation	12/6/2008
Q: I can't ask my question any better than I did in the subject. However, I do have Medicare Parts A, ... A: If the doctor says it is medically necessary, it is covered. I am guessing that AC indicates a ...
Medicare and meaning	12/4/2008
Q: I have just applied for Medicare A&B. In NJ you have to apply thru Social Security. I was on SSD ... A: Problem is there is a mix of regulations between different Departments. When someone drafts a law ...
Humana HMO and Medicaid	12/2/2008
Q: I need some help to determine what is appropriate for my Mother In Law. She is a Title 19 recipient ... A: She should have just received a copy of Medicare and You 2009 from Medicare. If not go to the ...
Supplemental Ins	12/1/2008
Q: Advantage health is no longer lutheran preferred and needing to find medicare supplement ins that ... A: You should have just received a copy of Medicare and You 2009. If not, go to the local Social ...
Can we still sign up for Medicare coverage	11/27/2008
Q: My wife receives SSA disability. I had insurance and we chose for her not to be covered by Medicare. ... A: Yes she can. There are some time elements involved so I can not give you an exact answer without ...
medicaid	11/25/2008
Q: My 95 year old father in law no longer has any assets. He guarantee a business loan of mine with ... A: This is too long and complicated to be done by e-mail. Your father should have just received a CMS ...
Medigap premiums	11/20/2008
Q: How can some companies offer me Medigap or supplement insurance at no cost? I was told they receive ... A: Medicare has two types of payment systems Under original Medicare, you have the Medigap plans as ...
Medicare primary or secondary	11/19/2008
Q: My husband is age 54 and has been disabled for three years. He has became enrolled in Medicare Part ... A: If he is still working at the Company, it is primary. If he is not working, then Medicare is ...
large invoice from Medicare	11/16/2008
Q: My mother in law passed back in May, her husband is now receiving large bills from medicare ($20,000 ... A: Not much information to go on, BUT, Medicare would not be going after the home. T think you are ...
Medicare/Medicaid/AARP	11/15/2008
Q: My grandparents (grandpa born in 1934, grandma born in 1937) receive both medicare and medicaid. ... A: This is too long and complicated to be done by e-mail. Your grandparents should have received a ...
certificate of coverage	11/14/2008
Q: Iwill go on medicare 12-01-08. I have cobra insurance ending 11-30-08, no more coverage after ... A: HIPPA regulations state that when your COBRA insurance stops, you have 63 days in which to get other ...
MEDICARE DRUGS: HUMANA OR MEDCO?	11/12/2008
Q: I am retired, on SS/Medicare (not eligible for Medicaid) and presently have Humana for my ... A: You should have no problem. They are mostly Medicare trained volunteers , and Ohio is one of the ...
MEDICARE DRUGS: HUMANA OR MEDCO?	11/12/2008
Q: I am retired, on SS/Medicare (not eligible for Medicaid) and presently have Humana for my ... A: Because the plans in each State are different it is hard to do by e-mail. If you are good with a ...
out of state payment	11/11/2008
Q: My niece has Itp and her platlets are always down. She has been treated at Duke Hospital in NC for ... A: This is too complicated to be done by e-mail. Therefore I am referring you to the SHIP ...
Secure Horizons Medicare Advantage Plan	11/10/2008
Q: My mother is 82 and retired - her former employer provides her with health insurance under their ... A: I checked back on my reports and found almost the same question, but a different person. Sorry ...
medicare coverage on a cruise	11/10/2008
Q: Does medicare and my supplemental insurance cover me if I take a cruise out of the country? A: Basically Medicare does not cover out of the country treatments unless: In an emergency, the ...
Medicare	11/9/2008
Q: Just heard about a plan called Blue Cross Stand Alone Medigap Plan C that is $107.09 per month. Can ... A: You must be in Michigan Plan c goes with original Medicare, and pays the deductible and the 20% ...
medicare while I am employed	11/7/2008
Q: I am 66 and enrolled in Medicare Part B, and annual enrollment is undderway at my employer. I am ... A: There are too many IFS, ANDs and BUTs for this to be decided by e-mail. Prescription coverage also ...
Medicare Hmo and Hospice	11/4/2008
Q: Patient is in hospice but the reason for her visit to an acute care facility is not related to her ... A: If patient has an Medicare Advantage HMO Plan, the plan is responsible for payment when: You ...
Medical insurance	11/2/2008
Q: I am the only provider for medical insurance for my family. When I turn 65 (my wife is 10 years ... A: The only difference is that for you Medicare will become primary coverage. For her there will be no ...
Medi-gap Insurance while living in Europe	10/30/2008
Q: I am living and working in Ireland. I turned 65 in January 08 but only applied for Medicare when I ... A: Ah yes, tis true. You will have to apply for Part B in Jan-Feb-March of 09. This is a must or you ...
BCBS wants to force wife to enroll in Medicare Part B	10/29/2008
Q: Here's myMy wife has been disabled for many years now and has been collecting SS disability for ... A: There appears to be a problem that would be hard to do by e-mail. Therefore I am referring you to ...
Medicare	10/27/2008
Q: A couple of years ago I retired at 62 and at the time was also granted disability due by Social ... A: If I read this right you are on your working spouse's employer health plan. You presently have no ...
Medicare denies test as not meeting medical necessity per LCD/NCD guidelines can you bill Medicaid?	10/22/2008
Q: #1. If Medicare denies test as not meeting medical necessity per LCD/NCD guidelines can you bill the ... A: 1. Because each State has different regulations for Medicaid, I can not give a positive answer. ...
balloon policy	10/21/2008
Q: I am on Disability and have Medicare, as I have fibromyalgia and MAJOR depression. I am prescribed ... A: Now is the time to make changes ,from Nov 15th to Dec 3l, with starting date of 1 Jan. The plans ...
Primary and secondary insurance	10/21/2008
Q: Are there any general "rules" regarding secondary payers? I have a situation where the primary ... A: It sounds like you have a policy that is sold in eastern US, referred to by billing personell as a ...
Using Medicaid out of state	10/20/2008
Q: My 4 year old daughter is currently covered by Medicaid in Florida. She is staying in Illinois with ... A: Does not work. The Medicaid program is operated by the individual States. Each have their own ...
Medicare Primary - Medicaid QMB	10/15/2008
Q: If a patient has Medicare Primary and has applied for Medicaid - can they sign up to a Medicaid HMO, ... A: Usually you will end up with Medicare and Medicaid which makes you a dual eligible. Along with that ...
changing medicare to primary and suppliment to secondary	10/15/2008
Q: I have a family member who's secondary insurace is Medicare and primary insurance is Advantra GHP- ... A: This appears to be a situation where the family member is on a working spouse or their own ...
coverage for spouse	10/12/2008
Q: I am employed at a hospital and I provide hospitalization for both my husband and myself. He will ... A: If he is already drawing social security, he should receive his Medicare card somewhere around May ...
do I need medicare part B	10/12/2008
Q: I am retired and have Blue Cross Blue Shield Federal Basic plan insurance. Do I need medicare part ... A: If you are retired and 65, Medicare becomes the primary insurance. So you will need Part B, ...
out of network surgery/ kaiser refuses to pay	10/8/2008
Q: My boyfriend was in a motorcycle accident, was taken to UCI Med center with a broken back. Surgery ... A: There is a missing factor here. Did he have any kind of accident insurance. If so, then the ...
OVERPAYMENT ON PRISCRIPTIONS	10/6/2008
Q: I PAID FOR RX,S BECAUSE THE PHARMACIST TOLD ME HE COULDN'T GET THEM TO GO THROUGH THE COMPUTER I WAS ... A: You need to sit down with the SHIP counselor from your area. They are trained by CMS to assist with ...
Medicare and Tricare	10/3/2008
Q: John, I was medically retired from the military in March 2003. I was eligible for Tricare Prime ... A: Makes no sense to me, The important date is the date SS picks to make you eligible for SS ...
Medicare Share of Cost	10/2/2008
Q: I am writing in concern of my mother just got approved for Medicare Share of cost in Orlando, FL. It ... A: Her Medicare card is proof of coverage under Medicare and most doctors accept it. If she is in ...
Medicare	9/29/2008
Q: To follow up with what someone else ask about switching form a medicare program (ie-Blue Shield) to ... A: You appear to be in an Advantage plan, an HMO. To go from one advantage plan to another, you simply ...
Submitting bills to medicate	9/28/2008
Q: I would like to purchase a power wheelchair online. There is a significant difference if the ... A: Suzanne What you want to do sounds good, but it is the hard way to go and very frustrating. Also ...
medicare insurance with AARP secure Horizons in colorado	9/26/2008
Q: My mother in law has been living in Denver area and will be relocating to New Mexico due to ... A: When she moves out of a plan coverage area she is entitled to change plans, and if she does so ...
Breast reconstruction after mastectomy for breast cancer	9/25/2008
Q: If a woman has breast reconstruction after a mastectomy for breast cancer, does her managed medicare ... A: The doctor is the one that makes the decision if it is medically necessary and assigns the proper ...
Medicare	9/22/2008
Q: My mom lives in Central Oregon, approximately one hour to two hours from Boise ID. In July of 2007, ... A: You asked about Medicaid, so that is what I will address. I am in Michigan, and since the ...
Medicare Medicaid dual billing	9/22/2008
Q: I currently work for a podiatrist that sees many Medicare/Medicaid eligible patients. They are ... A: I can not answer this question because it is out of my expertise . However it sure looks like ...
mother-in law says she does not have medicare	9/22/2008
Q: My motherinlaw is 90 years old and only has about 700 a month from social security. She does not ... A: Go to Benefits.com and enter her information. They will check about 400 programs and come up with ...
Inheritance to make son inelligible for medicaid?	9/19/2008
Q: In Missouri, my 26 year old son is diagnosed with diabetes and an extreme case of depression, has no ... A: Sorry, but you just about have it all figured out. Medicare regulations vary from State to State. ...
COORDINATION OF BENEFITS WITH TWO HEALTH PLANS AND MEDICARE	9/17/2008
Q: Our member is actively at work under age 65 for a group of more than 100. Her spouse is retired ... A: Hard to tell. Normally it would be his plan, then hers, then Medicare. But the commercial ...
moved, hmo not covering my area	9/17/2008
Q: My mother-in-law is now living with us. needs 24/7 care. Her HMO(healthsprings) doesn't recognize ... A: Go to Medicare.gov===scroll down to and click on Compare plans in your area===search the plans and ...
Medicare while fully employed and having coverage under wife's health ins	9/14/2008
Q: I am 64 and own my own law practice as a corporation. My wife is a college instructor in the state ... A: About two months before you are 65 go to the local Social Security and apply for Medicare part A. ...
Medicare vs Private insurance	9/12/2008
Q: am 69, still working and have a very good Harvard Pilgrim HMO. My wife and I each have our own ... A: Lots of if's and's or but's. Part B would cost about $100 a month each. An HMO about $60 a month ...
TENS Unit	9/10/2008
Q: I received my Disability based upon severe Fibromyalgia, Narcolepsy, etc. I actually bruise all ... A: If you have Medicare and your treating doctor says the TENS is medically necessary. he/she will give ...
Medicare, Supp, Med Adv and Cancer	9/5/2008
Q: Background. 70 year old father-in-law has cancer, took LTD and was terminated 7/19/2008 because he ... A: Right now is kind of a bad time to make the change, Reasons follow' When you make the change, make ...
Medicaid and Medicare	9/2/2008
Q: I have a client who suffers from terminal ovarian CA. She has been on Medicaid in the state of Il ... A: She keeps part B of Medicare, gets a gap policy; applies for the Medicare Savings program which will ...
getting Medigap due to coming off private insurance	8/27/2008
Q: Hubby disabled since 1994. Turned 65 in June, 2005. Have had him on my group insurance since 1989, ... A: This is too long and complicated to be done by e-mail. Go to the local Social Security Office and ...
HMO denies SNF for no prior authorization.	8/27/2008
Q: When an HMO denies a Skilled Nursing Facility for no prior authorization? What recourse does the SNF ... A: When you have an HMO you have to use one of their providers or the HMO will not pay. If a patient ...
Co-payment collections at time fo service and responsibility to file medicare for same	8/25/2008
Q: My company insurance plan is primary and Medicare is secondary. Some providers want to collect my ... A: It appears that you have done all possible to get this settled. See if there is a reason that your ...
Co-payment collections at time fo service and responsibility to file medicare for same	8/24/2008
Q: My company insurance plan is primary and Medicare is secondary. Some providers want to collect my ... A: The correct procedure is" Provider files claim with primary. Primary pays their portion and sends ...
Co-payment collections at time fo service and responsibility to file medicare for same	8/24/2008
Q: My company insurance plan is primary and Medicare is secondary. Some providers want to collect my ... A: Hard to tell from the information given. Call the Coordination of Benefits(COB) at 1-800-999-1118 ...
United Healthcare	8/19/2008
Q: John, My daughter has been seeing specialists at UNC-Chapel Hill for over a year now. The insurance ... A: COBRA is under the US Labor Department regulations. Contact their nearest office and submit a ...
part b	8/17/2008
Q: in 2001 my firm refused to cover me with its group health because i was 65 and the firm had less ... A: You just about answered your own question. Your employer insurance is primary and Medicare is ...
How to cancel Medicare HMO without probs	8/16/2008
Q: I returned to Florida from a vacation to find my 88-year-old friend had been admitted to a Hospital ... A: This is too complicated to be done by e-mail. I suggest you get in contact with my counterpart in ...
Medicare/Medicaid	8/16/2008
Q: I receive Medicare/Medicaid in SC, I am on disablity due to many health problems. I desperately need ... A: The Medicare regulations are different in each State and I am in Michigan. However the federal ...
Medicaid	8/15/2008
Q: I have Texas medicaid & was wondering if you know if they cover Lap Band Surgery? If you don't know ... A: Because of the differences in regulations in different states, I can not answer the question. ...
tricare and medicare	8/13/2008
Q: I have had tricare ins. for years and was recently awarded Soc. Sec. Disability benefits and ... A: By Federal Law. TRICARE must be the payer of last resort. Their ruling is that if a person in ...
Handicap sister and Blind Mother	8/12/2008
Q: My hanicap sister (60yrs) and Mother (80yrs) are dual eligible. They get Home assistance for 7days ... A: Look up the nearest Area Agency on Aging in your area. They handle most of the services to the ...
Gastric Bypass Surgery	8/12/2008
Q: i have health plan of michigan through medicaid, i am 23 years old and weigh nearly 300 lbs. i am ... A: Ask the people that make the determination. One is your case worker. The second is the doctor ...
medicaid and inheritance	8/11/2008
Q: My grandmother died this year and left me a small inheritance in the form of bonds. Both my 13 year ... A: Because the Medicaid regulations vary from State to State I can not answer this question. The ...
Dad moved suddenly out of HMO area, not yet covered by Orig. Medicare	8/6/2008
Q: My dad was hospitalized for 4 days (July 14-17)in Florida where he lived, covered by his AARP ... A: The part of care denial by the HMO does not make sense. It seems his doctor would have prescribed ...
Secure Horizons versus Kaiser Senior Advantage	8/5/2008
Q: I turn 65 this year and have to decide which supplemental plan to choose with my medicare. I am a ... A: There are too many factors to consider for this to be done by e-mail. Since I am in Michigan I am ...
Medicare /HMO Elig Date Constant Turmoil	8/4/2008
Q: I supervise the billing/collection of Medicare/Medicaid claims for a local hospital. When Medicare ... A: I suppose that you have also called the Medicare number and talked with an appeals specialist. So I ...
Medicare /HMO Elig Date Constant Turmoil	8/4/2008
Q: I supervise the billing/collection of Medicare/Medicaid claims for a local hospital. When Medicare ... A: This is outside of me expertise, so please do not blast me for not knowing the answer. This may be ...
doctor didn't submit timely claim to medicare	8/1/2008
Q: I am trying to figure out the rights and duties in regards to doctors and getting medicare to pay ... A: Call 1-800-Medicare, you will get a voice system , immediately say agent and it will get you to a ...
Medicaid	7/31/2008
Q: I live in NY state.Last year I had a medical emergency and was in the hospital for 3 months.My ... A: While they are basically the same there are several variations in the regulations in each State. ...
medicare	7/28/2008
Q: my mothere receives medicare part a part b she has to pay 74.00 a month for a tiny bottle of ... A: She is supposed to have a Prescription Drug Plan(PDP). If so it would normally be paid by the PDP. ...
medicare, medicaid	7/27/2008
Q: if you go to the dr/hospital and you are covered by medicare or medicaid if they pay are you ... A: If you have Medicare alone, you are responsible for the deductable and the co-pays. You would need ...
BCBS/Medicare Advantage Plan and Coordination of Benefits	7/26/2008
Q: I have BCBS primary and Secure Horizons Medicare Advantage Plan/Tx. BCBS pays promptly except for ... A: Horizons is an Medicare Advantage and is not designed to be a supplemental to another plan. You are ...
BCBS/Medicare Advantage Plan and Coordination of Benefits	7/26/2008
Q: I have BCBS primary and Secure Horizons Medicare Advantage Plan/Tx. BCBS pays promptly except for ... A: This is really too long and complicated to be done by e-mail. There is an indication you are in ...
BCBS/Medicare Advantage Plan and Coordination of Benefits	7/26/2008
Q: I have BCBS primary and Secure Horizons Medicare Advantage Plan/Tx. BCBS pays promptly except for ... A: It sounds like you have two Medicare Advantage plans or an employer plan and an Advantage plan. ...
Disenrollment Complaints	7/24/2008
Q: I have been trying to Disenroll from kaiser and Joined AARP and kaiser keeps refusing to comply with ... A: That is probably because that is the way that the regulations are written. There are some ...
Transferring medicad	7/23/2008
Q: My aunt lives in FL. Her only relatives, my parents, are moving to MI. We want to move my aunt ... A: Go to Michigan.gov======click on site map======scroll to health======click on assistance ...
Can I and How do I go about switching my dad's HMO Medicare	7/22/2008
Q: My dad is in a lot of pain and I have been given the run around as to how he should be treated. I ... A: Kathleen Go to the local Social Security office and pick up a copy of Medicare and You 2008. It ...
Medical scooter	7/20/2008
Q: My grandmother is having a hard time getting around and I want to help her to get a hoveround or ... A: It all depends if the doctor writes a prescription that says it is medically necessary. Then you ...
Medication	7/20/2008
Q: My husband is 57 y/o and receives SSI disability. Recently he got a letter telling him that he has ... A: Read that letter and it will probably show a starting date for Medicare as of Nov 1. Therefor it ...
2 medical insurance	7/20/2008
Q: if there's 2 insurance companies such as medicare and bc/bs medigap, which company would pay the ... A: There are really not two companies involved here. Medicare is a federal insurance program. The ...
Medicare supplemental part B and part D	7/18/2008
Q: My father has been accepted as a Medicaid recipient. We have recevied confirmation from the SS ... A: Check with the SSA office and find out if he has the Limited Income Subsidy(LIS), Sounds like he ...
Secure Horizons & Medicare	7/18/2008
Q: My parents (ages 79 and 82) signed up for Secure Horizons (rep knocked on their front door) and ... A: first of all, go to the local Social Security Office and pick up a copy of Medicare and You 2008. ...
New to Medicare need assistance	7/17/2008
Q: I am on ss disability my Medicare coverage will begin Oct 2008. I am entitled to 100% subsidy for ... A: In August go to the local Social Security office and: Pick up a copy of Medicare and You 2008. ...
Should my wife sign up for Part B - she has ESRD	7/13/2008
Q: John: My wife will end her 30-month period where the private insurance is the primary provider at ... A: You are all set. As long as you are employed and the insurance is creditable coverage, Medicare is ...
COBRA	7/9/2008
Q: My husband lost his job, but we have medical coverage from this former employee until July 20th. He ... A: Well you will be without insurance for 10 days. If you get new insurance within 63 days after ...
disability, medicare vs private insurance	7/8/2008
Q: My husband is 46, and just last month got approved for disability for an injury he suffered five ... A: One of you options is to drop your present insurance. If that happens, you would have to get ...
disability, medicare vs private insurance	7/8/2008
Q: My husband is 46, and just last month got approved for disability for an injury he suffered five ... A: Go to the local Social Security Office and pick up a copy of Medicare and You 2008. It has a wealth ...
Medicaid coverage--moving to a new state	7/7/2008
Q: My family currently resides in WI and are covered under the state's Badgercare program which falls ... A: The information you received is correct. Medicaid is run by each individual State and the ...
hysterectomy with concurrent abdominoplasty	7/7/2008
Q: I have traditional Medicare parts A&B and have American Family Medigap insurance with all the ... A: It all depends on how the doctor codes the procedure. If he says it is medically necessary it will ...
Wanting to learn	7/3/2008
Q: I am a recent graduate with a Masters Degree in Social Work. I feel as though my knowledge of ... A: Go to the local Social Security Office and get a copy of Medicare and You 2008. In the center of ...
medicare A&B with supplement	6/30/2008
Q: My father in law lives in Pa and retired . He picked up Medicare A&B. American Progressive, Todays ... A: Medicare has 2 payment systems, Original Medicare uses the Medicare card as the ID. He is in a ...
medicaid for 62 year old	6/30/2008
Q: I will be moving to ohio next summer. Ill be 62 years old and Ill be receiving social security of ... A: Basically Medicaid is age related at 65. Many States have other services in their Medicaid program. ...
Medicaid as a secondary insurance	6/29/2008
Q: My husband's daughter lives with her mother in a different state (Ohio). In the divorce decree, he ... A: Lt is advisable to call the Medicaid office and make sure that they are aware of the situation. The ...
Medicare - age discrimination	6/20/2008
Q: I am a young person (47) on SSDI and Medicare. A Medicare doctor who accepts assignment was ... A: Sorry====BAD NEWS Just had another one of these yesterday. Checked with an elder law lawyer that ...
Gap in health insurance coverage	6/20/2008
Q: I have a question regarding a gap in health insurance coverage. My husband and I are currently on ... A: You have 2 separate issues. The first is being without insurance for a period of time. That off ...
Medicaid	6/20/2008
Q: I live in Ga and my monthly income is 400.00. My rent alone is 200.00 and it includes utilities, and ... A: Cindy That does not sound right. Because there are different Medicaid regulations in each State, ...
Medicare	6/18/2008
Q: My father has heard of an injection that could possibly alleviate his knee pain due to ... A: Normally, I would have sent an e-mail saying that this is outside of my expertise, because I do not ...
Medicare Advantage Plans/Medigap	6/17/2008
Q: John - I will be going on medicare in August. I have received tons of mail and have tried to sort ... A: well they all work. A lot depends on you lifestyle and health. Original Medicare with a Medigap ...
medicare pffsplans	6/12/2008
Q: i enrolled in a plan on the 19th of may this is my first time in medicare is this a good type of ... A: All the plans are good in their own ways. What matters is your preference of the different plans. ...
mobility sccoter ND	6/12/2008
Q: My mother is on social security, medicare and medicaid. She is 90 and starting to have a hard time ... A: Start with your doctor and see if he will give her a prescription for a scooter, If so then go to a ...
Nursing home charges	6/9/2008
Q: This is so messed up -- I'm not quite sure where to begin. My husband has alzheimer's ( has had ... A: Each State has different Medicaid regulations and also different Recovery Act regulations. You ...
Humana	6/8/2008
Q: My wife is disabled and has been for over 30+ years. Is covered by Medicare Secondary for body ... A: From the limited information given, it would appear that things are going the way they should. In ...
Medicare advantage/no retro review	6/6/2008
Q: My question is from the provider end...I am a RN liaison that works for a skilled nursing facility. ... A: Go to Medicare,gov====scroll down and click on provider manual===scroll down to the one for SNF ...
Inheritance	6/5/2008
Q: My uncle is in a retirement home and his care is paid for by Medicade. He is about to inherit about ... A: There are too many variables to give an accurate answer, one of which is the difference in Medicaid ...
Paying back Medicaid after death	5/29/2008
Q: I understand if someone owns a home and utilized Medicaid services, the funds provided for services ... A: Boy, you do not ask the easy ones. Years ago the government passed a regulation that each State ...
Medicare Summary Notice	5/29/2008
Q: My mental health coverage under medicare is 50% of approved amount. My Medicare Summary Notice ... A: There are two reasons I can not give a good answer to you question. Not enough information and ...
insurance coverage	5/26/2008
Q: I have medicare A&b also medicaid will these insurances pay for lapband surgery age 53 state of ... A: In the Medicare system it is the doctor who assigns the payment codes on the claim forms. So the ...
Medicare as secondary insurance	5/24/2008
Q: We moved to another state in the last couple of months before my retirement, so my insurance ... A: A real can of worms as mu grandfather used to say. Too complicated to be solved by e-mail. ...
My father and his terminal illness with cancer	5/21/2008
Q: I understand that there is a waiver with ALS for the 24 month waiting period for eligibility after ... A: Sorry, but there is no way to shorten the waiting period for Medicare in this situation. HOWEVER, ...
Medicare ()PPS) Outpatient Prospective Payment System	5/19/2008
Q: No one seems to be able to give me the math or formula used so I can be sure they are corret. The ... A: Pretty tricky. Go to Medicare.gov; click on Medicare part A; Keyword Outpatient Prespective Payment ...
Medicare/Medicaid	5/17/2008
Q: Are Medicare participating physicians also automatically Medicaid participants? I am a Dual ... A: No, they are entirely separate programs. Medicare is a Federal program and is usually considered an ...
medicaid/braces	5/15/2008
Q: My daughter is on Medicaid and we live in Florida. Does it cover orthodontics, specifically braces? ... A: Sorry, I am in Michigan and the Medicaid regulations are different in each State. The person that ...
medicare, group health insurance, workers comp	5/13/2008
Q: I live in Texas, am 39 and disabled, I have health insurance with United Healthcare through my ... A: In all probability you will save money by going to full Medicare. However, remember that once you ...
copayment time limits w/r foreign travel emergency	5/12/2008
Q: I have Medigap-J supplement. Was injured while overseas in mid December '07. I needed additional ... A: Medicare does not work like liability insurance. The deductible happens once a year and not once an ...
medicare and/or individual insurance	5/10/2008
Q: my wife (28) is legally blind and will get medicare starting June 1st because I lost my group health ... A: First it makes no sense having two insurance systems. They would not be compatible and there is a ...
Cobra/hmo's/part B?	5/8/2008
Q: I am divorced from my wife. We are on good terms though. For the last year I have paid out of pocket ... A: ai believe you ment that she got her Medicare card in 2007 and not 2008. If the card had Part B on ...
long term care	5/6/2008
Q: Usually it's said that those services covered by MEDICARE are not eligible to get LTC Insurance ... A: Long term care(LTC) insurance can be purchased by anyone and is designed to cover persons in a ...
Medicare code pr49	4/21/2008
Q: I am power of attorney for a disabled friend(age 42) who has regular medicare and Blue Cross ... A: There is really too many missing factors to give you a good answer. There is some question if the ...
Medicare HMOs claim prosessing	4/21/2008
Q: I am a in-patient hospital service provider. I am not an in-network provider for HUMANA and or ... A: Sorry but this is out of my expertise and normally I would not send an answer. However, I would ...
Out of Country Medicare Coverage?	4/17/2008
Q: My father and mother travel to India for 6 months a year. About a month ago in India, my father had ... A: Medicare does not cover them overseas. If they have a medigap policy as a supplement, they may be ...
transfering medicare	4/14/2008
Q: My grandmother is in a nursing home in Fla. and has medicare to cover her care,but just 3 weeks ago ... A: Her Medicare coverage will be just the same. I think what you are referring to is Medicaid. Since ...
Medicare/Medicaid & Private Insurance	4/14/2008
Q: John, I read where you specalize insurance questions especially in Michigan. I live in Michigan and ... A: The source for this information is Medicare itself. Go to Medicare.gov====click on publications and ...
Breast Lift/Abdominoplasty after gastric bypass on Medicare	4/12/2008
Q: I have Medicare through a Humana advantage plan. They covered my gastric bypass on 3/07. I have ... A: The ones that decide coverage are the provider and the Managed Care plan. In general the provider ...
medicare, medicaid tmd coverage	4/11/2008
Q: my son has suffered from severe facial spasms apparantly due to tmd symptoms. does medicare or ... A: I can not be of much help. Medicare does not cover dental, however adjustment to jaws etc, may be ...
Medicare	4/8/2008
Q: Should I be in a Medicare plan since I have Blue Cross Blue Shield at work. A: Not enough information to give an answer. However usually: You should have Part A. You ...
Medicare won't pay my medical bills.	4/4/2008
Q: I am 67 and have Parts A&B Medicare coverage. I opted out of Kaiser Sr. Advantage as of 1-1-08 and ... A: Call the Coordination of Benefits(COB) 1-800-999=1118 and ask what your exact status is. That is ...
redo breast reduction and tummy tuck	4/3/2008
Q: I had a TT and a BRduc. 2 years ago. My left breast and nipple hurts to the touch and there is a ... A: This is a COBRA question. That type of insurance is a continuation policy from your or you ...
Health insurance when you retire to a foreighn country	3/31/2008
Q: A colleague of mine--a professor--plans to retire to her birthplace of Jordon. If she stayed in the ... A: Medicare will not provide coverage to her once she goes to Jordon. Her claims from there will be ...
HMO denied Arenesp	3/29/2008
Q: MY insurance Humana HMO has denied to allow me to have my weekly Arenesp shot which I need weekly ... A: I am not familiar with the particular Humana plan that you have. It appears that it is not on their ...
MEDICARE SUPPLEMENTAL INSURANCE	3/17/2008
Q: I HAVE BEEN ON MEDICARE SINCE 1994 AND HAVE NEVER SEEN A DENTIST AGAIN BECAUSE I JUST CAN'T AFFORD ... A: Sorry, but dental is not covered by Medicare. some of the Advantage plans offer limited coverage. ...
Medicare Advantage Plan coverage for out-of-network	3/16/2008
Q: My wife will be 65 in October and we are confused on out-of-network coverage for the various ... A: I suggest you go to the nearest Social Security office and get a copy of Medicare and You 2008. It ...
out-of-state coverage	3/13/2008
Q: My father-in-law was diagnosed with pancreatic cancer back in September of 2007. He is a Wisconsin ... A: Jessica, Hi again It appears to be a question of what drug is covered for what and that is outside ...
out-of-state coverage	3/12/2008
Q: My father-in-law was diagnosed with pancreatic cancer back in September of 2007. He is a Wisconsin ... A: AARP also sells Advantage plans. Since you used the word supplemental, I have to assume he has a ...
Medicaid	3/7/2008
Q: I know you can not answer questions about his topic, but would you be able to tell me who to call to ... A: If you do not have a copy of Medicare and You 2008, go to the local Social Security office and pick ...
Gap between COBRA and Medicare	3/5/2008
Q: I was just laid off, and I plan to get COBRA immediately. However, the 18-month COBRA will end ... A: You have it pretty well figured out. I do not suggest you go without health insurance for three ...
coverage of nursing home expenses	3/3/2008
Q: My dad is in a nursing home doing private pay. His house is up for sale, but he has only about 6 ... A: When it comes to protecting assets it is almost impossible to answer your question unless I was in ...
Mothers' Mericare and Medicaid	3/2/2008
Q: My mother was admitted to a nursing home on 1/7/08 with a broken hip and broken shoulder. She has ... A: You did not indicate what kind of an insurance plan BC/BC was. Not being from NC I would not know. ...
Moving parent from MI to VA,	2/27/2008
Q: My mother-in-law has medicare, a Blue Cross Blue Shield medigap policy, and, I think, a AARP part D ... A: You are talking about the Medicare Advantage plan, HMO etc With the Medigap and BC, you have to be ...
Moving parent from MI to VA,	2/27/2008
Q: My mother-in-law has medicare, a Blue Cross Blue Shield medigap policy, and, I think, a AARP part D ... A: Sorry, but I do not know if VA has a special open enrollment for gap plans. However she can use the ...
Medicare	2/22/2008
Q: I saw your answer to Linda (2/11/08) - I'm also turning 65, will be employeed until 66 - about 15 ... A: Sorry about the delay. I answered the other night and on this site when I hit send, it clears my ...
Reimbursement Consultants	2/22/2008
Q: Good Morning, Thank you for making yourself available to answer this question. I'm trying to learn ... A: Sorry again Still can not help. That is not in my area of expertise. Just a guess BUT: for ...
Reimbursement Consultants	2/22/2008
Q: Good Morning, Thank you for making yourself available to answer this question. I'm trying to learn ... A: I have been doing this for 15 years and have never heard of the tern Reimbursement Consultant. I am ...
Medigap or HMO	2/19/2008
Q: I am turning 65, have 3 stents in my heart, history of heart attack. Why pay $170 for a supplemet, ... A: Freedom: With original medicare and a Medigap, you can go to any provider that accepts Medicare, ...
Medicaid, UPHP	2/16/2008
Q: I am currently on disability and my car insurance went up because I am on Medicaid. Does ... A: Medicaid is the payer of last resort. Therefor when you went on Medicaid your car insurance went ...
Medicare	2/12/2008
Q: I turn 65 this May and I am employed and have health coverage. I am going to register for Medicare ... A: I have to back off what I said before. I WAS NOT AWARE THAT WITH CHAMPVA YOU DID NOT HAVE TO GO TO ...
switching from HIP Medicare	2/11/2008
Q: I live in Staten Island,New York. I currently have HIP Medicare. I am a 55 year old female. My ... A: There are just too many items to cover to do this by e-mail. You really need to have someone sit ...
Medicare	2/11/2008
Q: I turn 65 this May and I am employed and have health coverage. I am going to register for Medicare ... A: As long as you are employed and have health insurance, you will not need part B If you have ...
Medicare Plan B drop	2/10/2008
Q: John, Thank you for your help. I read some of your answers to other people and wonder now what to ... A: There may be a simple answer. There is a strong possibility that the Coordination of ...
medical bills in collections	2/8/2008
Q: My son had to go to the er in 2005 because he was very sick. His dr couldnt see him, but ok'd him ... A: Sorry, but I can not be of much help. Medicaid regulations are different in each state and I am in ...
Medicare and HMO	2/5/2008
Q: My office is in Ohio, Patient comes in and states she has Medicare. Denial comes back from MC ... A: You can bill her OK, however it is the responsibility of the Medicare provider to check and see what ...
best medigap insurance	2/1/2008
Q: I am totally confused with all the options for medigap insurance. Can you recommend a medigap ... A: Sorry, but I am in Michigan and Wisconsin is one of three States that have their own system for ...
Medicare/Supplement	1/30/2008
Q: We have a patient (age 63) that is retired and has insurance for him and his wife (age 68) through ... A: Someone goofed. Once he stopped working and his wife was eligible for Medicare, Medicare would have ...
Secure Horizons Medical Advantage Plan	1/30/2008
Q: We are enrolled in this plan. However, Secure Horizons has advised us that they enrolled us in ... A: Hard to say. Computer may have an indication that you are in a continuation area. I have no way of ...
Secure Horizons Medical Advantage Plan	1/30/2008
Q: We are enrolled in this plan. However, Secure Horizons has advised us that they enrolled us in ... A: All you have to do is enroll in another Advantage plan. This enrollment will automatically drop you ...
Lap Band Surgery and Medicare	1/29/2008
Q: I am a paraplegic who is grossly obese and desperately need bariatric surgery (preferably Lap Band). ... A: Sorry I cannot be of much help. The doctor is the one that assigns the claim codes for different ...
Medicare/Health Care Advisors	1/28/2008
Q: Are there specialists/advisors who will help seniors decide what health care programs are best for ... A: You can reach the Medicare Counseling service for the State of Massachusetts at 1-800-243-4636. It ...
Inheritance after using SSI and Medicaide	1/24/2008
Q: Does the State take an inheritance, as real estate, if they have SSI and Medicaide for two children ... A: That is a question that would require a lot of back and forth e-mails to answer. Also it depends on ...
Fraud on Medicare Billing	1/23/2008
Q: John, I just now discovered that some doctor billed Medicare two years ago for me a Heart Health ... A: It is a little late and the records of the transaction are probably in storage. However there is ...
Drop Private Insurance For Medicaid	1/23/2008
Q: We just found out that our 2-1/2 year old son has qualified for a Medicaid Waiver in KY. He is to ... A: Can not be of much help. I am in Michigan and the Medicaid regulations are different in each State. ...
Kaiser Senior Member and Group Health	1/17/2008
Q: we have a situation where the husband has Kaiser Senior Advantage. He is over 65 yrs of age. He ... A: I have no way of knowing how the school system health plan works. However assuming he is added to ...
medicare/medicaid trans. from NY to FL	1/15/2008
Q: My grandmother is in a nursinghome in NYS, has both medicaid and medicare. She wants to come to ... A: Can not be of much help. I am in Mi and the regulations for Medicaid are different in each state, ...
Medically necessary procedure	1/14/2008
Q: I've had 2 surgeries that have involved cutting my tummy. One hip-to-hip. the other was back surgery ... A: There are two basic requirements for Medicare to cover the payment. One the provider must accept ...
Blue cross Blue shiel card	1/14/2008
Q: Does BCBS card covers also the discounts on medicines when outside the country? My retired us ... A: Since I do not know what kind of a Blue Cross policy he has, or what the coverage and co-pays are. I ...
Medicare	1/10/2008
Q: My mother is 75 and has HIP of NY as a primary ins. I have tried to convince her to switch to ... A: I am in Michigan and am not familiar with the NY plans. She apparently has one of the Medicare ...
Cannot get a denial letter from Medicare, 3 tries so far	1/10/2008
Q: I've been trying for a year now to get a denial letter from Medicare so my secondary insurance (Blue ... A: This situation is too long and complicated to be done by e-mail. You need to sit down with a ...
Medicare HMO's	1/9/2008
Q: I am looking for information regarding Medicare HMO plans who reimburse the members instead of the ... A: You are looking for something that does not exist. The system you are looking for is the original ...
Medicare enrollment	1/8/2008
Q: I am still employed and my employer provides health insurance for both my spouse and I. My spouse ... A: a month or so before she turns 65 she should go to the Social Security Office and apply for Part A, ...
Medicare	1/6/2008
Q: Oh, boy where to start. I take care of a 80 year old lady, she really is quite capeable of takeing ... A: It would take too long to explain all this by e-mail. Go to the local Social Security office and ...
Medicare Part B penalty	1/4/2008
Q: I work for a government entity. In order for me to retire and draw my FRS retirement, I have to ... A: Normally I would not answer this because it is partially outside my expertise. In 14 years, this is ...
out of state coverage	1/2/2008
Q: She has New York Medicare and Medigap. Will they cover the out of state hospitalization? She needs ... A: You did not mention her prescription coverage. She should have a part D Prescription Drug plan(PDP) ...
out of state coverage	12/28/2007
Q: She has New York Medicare and Medigap. Will they cover the out of state hospitalization? She needs ... A: I would guess that she has either Medigap plan C or plan F. Both cover the gaps in hospital and ...
ESRD/ NYS Medicare A & B / Cobra Health Insurance	12/17/2007
Q: My sister in law has ESRD. She has been on dialysis many years. When her husband retires at end of ... A: COBRA; They are both entitled to COBRA. However, each one makes their own decision if they want ...
Medicare Health Ins etc	12/13/2007
Q: Client is retired, has company health plan including script co-pay and medicare as he is 80y/o. he ... A: In all probability the problem is with the company health plan and not with the provider billing ...
Medicare Reimbursement	12/8/2007
Q: John - I've researched my question on the Medicare and CMS websites, but can't find an answer. Do ... A: It is probably a legit use of time, but is also confusing to the patient. What really counts is ...
COBRA and Social Security dilemma	12/4/2007
Q: I was wondering if you could give me some advice. Even though I am in my 40s, I recently became ... A: I need more information in order to answer this question. When did your employment end? Were you ...
Should I change wife primary to Medicare	12/2/2007
Q: My wife trued 65 last year, I am 54. She has Medicare. We kept her on my employee insurance and used ... A: In all probability the best answer is to stay as is. Since she is on your insurance she does not ...
Medicare	12/2/2007
Q: My mother-in-law just recently had eye surgery. It was done as an out patient at one of our local ... A: This would take a lot of back and forth e-mail to solve. I suggest you talk with the local SHIP ...
paying to much	11/30/2007
Q: hope you can help im 66 years old and on medicare i also have aarp which i pay 218.00 a month for ... A: It appears that you have Medigap plan C from AARP You can get that almost anywhere for about $80 ...
secondary coverage	11/28/2007
Q: My father was denied secondary coverage from medicare advantage. He needs secondary coverage to be ... A: Advantage plans can deny coverage for a person that has ESRD. You did not mention what medical ...
Medicare while employed	11/24/2007
Q: My husband will be 65 in January 2008. He is employed as a university professor at a state school ... A: He should apply for Part A a month or two before he turns 65. There is no cost to it and it leaves ...
Two Medicare questions	11/16/2007
Q: I have a friend who has just gone on Medicare. She had cancer six years ago. She is now ... A: 1. She will have no problem getting supplemental insurance because of preexisting conditions. 2. ...
HMO's in Florida	11/16/2007
Q: I wondered if you knew about the HMO's for medicaid in Pinellas county, Florida. I am on SSI and ... A: You should have received a copy of Medicare and You 2008 by now. If you have not go to the local ...
cobra or medicaid	11/12/2007
Q: My daughter who is 27 was diagnosed with stage IV metastasis melanoma cancer terminal her job let ... A: There are a lot of questions I would need answered before I could really give a good answer to this. ...
About Dropping Medicare	11/10/2007
Q: My mother has gotten more information from medicare about what they WILL NOT pay. In the past her ... A: There seems to be something wrong here. With few exceptions Medicare covers just about everything ...
Medicare, Medigap, and Private Insurance	11/9/2007
Q: I have all 3 of the above referenced insurance coverage. The private insurance now runs me $37,000 a ... A: Frankly, you are wasting about $30,000 to $37,000 a year. Other than dental and eyeglasses and ...
How to get a Medicare denial letter for secondary insurance claim?	11/9/2007
Q: I am brand new to Medicare and need your help. I live in NJ. I have a bill from my provider who does ... A: From what you described, it sounds like you have what is known by known as a carve out policy. They ...
How to get a Medicare denial letter for secondary insurance claim?	11/9/2007
Q: I am brand new to Medicare and need your help. I live in NJ. I have a bill from my provider who does ... A: You should have gotten manual called Medicare and Your 2008 a few days ago. It will explain many ...
Medicare vs Employer group insurance	11/7/2007
Q: I am 60 and currently employed. My husband is on Medicare. My employer was recently purchased and ... A: Good news. There are three things to consider. When he begins coverage under your employee health ...
Employer insurance vs. Medicare	10/31/2007
Q: I am 69 and still working. My wife is 67 and not working. I am covered by my employer's insurance ... A: I assume that you both have Medicare. Probably just part A which is free. Because your insurance ...
Medicare and private insurance.	10/23/2007
Q: I live in Georgia. I am 65 and on Medicare and also purchased a Humana advantage plan. My wife is 60 ... A: good thinking. she off course will probably take COBRA. You have a choice. COBRA IS expensive, ...
Medicare and private insurance.	10/23/2007
Q: I live in Georgia. I am 65 and on Medicare and also purchased a Humana advantage plan. My wife is 60 ... A: first thing to do is to find out from where she works if you can get on the plan, what it covers and ...
Medicaid and Private Health Insurance	10/16/2007
Q: Our 22 year old-Downs Syndrome-son has his own health insurance policy with a $10K deductible. He ... A: Hal Thought if he were eligible for Medicare I would have an answer, I recommend that you look into ...
gastric bypass denied	10/15/2007
Q: I am hoping you can help.I am morbidly obese with many medical problems.My HMO ( Coventry of ... A: Bad news. That is the problem with HMOs. They have control over what is covered. While it may not ...
COBRA	10/15/2007
Q: I'm hoping you can help regarding a voluntary severance package I took from Alaska Airlines. Part ... A: Bad news. It sounds from the information you provided that they followed the rules regarding COBRA. ...
insurance commisioner	10/15/2007
Q: If possible could you let me know what steps I need to take in making the gastric and lapband ... A: Sorry, there is nothing you can do to correct this situation. It is a common problem. Doctors do ...
Medicare card	10/9/2007
Q: How do I obtain my FIRST/initial Medicare Card? A: Depends on a couple of things. You are entitled to Medicare in the month you turn 65. If you are ...
Oral surgeons through Medicare/Medicaid	10/4/2007
Q: I am a social worker and one of my clients needs to see an oral surgeon to get her wisdom teeth ... A: Medicare will not cover it. Check with her case worker and see if they have a list of dentists. I ...
Mom moving from OR to CA	10/2/2007
Q: My mother is 83 and would like to move to Los Angeles to be close to us, but she is fearful about ... A: Medicaid: Check with the case worker about transferring her coverage between states. She may have ...
QMB and share of cost	10/1/2007
Q: My mom is 64 years old. She live in Florida. She applied for medicaid and was denied but the ... A: I think there was a misunderstanding on what the case worker told you. Your mother should go to the ...
Medicare	9/30/2007
Q: Hallo John, When we are retired, my wife and I want to live in Florida. At this moment we live in ... A: Welcome to America. Medicare is for US citizens and is based on someone having worked for 10 years ...
transfer of HMO Medicare in CA to a group in NH	9/30/2007
Q: My mother-in-law lives in CA and wishes to move to NH. She has a Medicare HMO in CA; what is the ... A: First thing to do is to find out if the plan she has is a national plan or not. If national: ...
medicare/assets	9/29/2007
Q: My 89 yr old Mom has about $7,000 in savings/checking. Income SS only. She is afraid she will lose ... A: Hard to answer completely. Each State has somewhat different recovery laws. So going with the ...
soon will have no insurance	9/29/2007
Q: I currently have a job and I do have health insurance, but I don't expect this job to last. I have ... A: You could get COBRA when you leave the present employer, but very expensive. I think you might also ...
Better Deal - HMO or Medicare	9/28/2007
Q: My grandmother currently has Secure Horizons and is in need of in home health care (in hospice ... A: You did not say if the HMO was a work related HMO or a Medicare Advantage Plan. I would guess a ...
Medicare Supplemental Insurance	9/26/2007
Q: Is there a Supplemental Insurance that covers items that Medicare does NOT cover? (If so, how can I ... A: If you are in original Medicare, you go to any doctor of your choice; doctor bills Medicare, you ...
Medicare Supplemental Insurance	9/26/2007
Q: Is there a Supplemental Insurance that covers items that Medicare does NOT cover? (If so, how can I ... A: For all intents and purposes NO. There are some far out policies that might, but are extremely ...
Portability & SSI & Benefits	9/25/2007
Q: I am moving from Jackson County, Mi. to Pinellas county, Fl. and have already started the process of ... A: I am a site coordinator for the Medicare Medicaid Assistance Program(MMAP) in Wayne County. If you ...
Medigap versus Medicare approved HMO's	9/24/2007
Q: Pedit, I'm 70 and have been using Medicare approved HMO's since reaching 65. At this point, I'm ... A: Basically it is the nature of the person that decides which way to go unless cost is a factor or you ...
BCBS HMO Blue Texas	9/20/2007
Q: I have United Healthcare at my job and they have an exclusion for bariatric surgery. My husband ... A: There is no way of knowing the answer to your question without having receiving the Certificate of ...
Medicaid or Medical	9/17/2007
Q: What steps are necssary to be made for a disabled 61 yr old man, unemployed and hospitalized since ... A: I answered this but evidently there mail did not get through the process. No need to separate. ...
Fighting to go out of network with an HMO	9/14/2007
Q: My 3 year old daughter has cerebral palsy. We have Keystone Health Plan East and Helth Partners (PA ... A: You already seem to be doing the proper thing in that you are already doing an appeal. If that ...
Getting Off Humana	9/13/2007
Q: My mother is 56, on disability, and desperately needs full-time care in a facility such as a nursing ... A: If you submit a letter to Humana wanting to drop the plan, you should be able to drop it as of 1 ...
insurance refusal to pay	9/13/2007
Q: Person was taken to emergency room for heart attack, then taken down the hall on a gurney for heart ... A: Sounds like you have a person with either HAP or BC HMO. should have received a packet of ...
medicare	9/11/2007
Q: My husband will turn 65 next year. He is retired and has health insurance with the company. We ... A: When he becomes eligible for Medicare the company insurance will probably require him to get A and ...
va and medicare	9/7/2007
Q: john, is there a penalty for declining part B medicare if I later decide to get it. i am currently ... A: I am afraid I have bad news. There is a 10% penalty for each 12 months that you delay getting part ...
Medically necessary sitters	9/6/2007
Q: My father is a 85yo widower with a disease called Parkinson's Plus that causes him to fall down ... A: Unfortunately Medicare and Aetna will not cover the sitters, and since he does not have eligibility ...
Medicare vs. employer insurance	9/4/2007
Q: I work full time and will continue to work until I am 70. I will be 65 this December 2007. Is it ... A: Probably better off keeping the work coverage. Go to Social Security and apply for Part A Medicare. ...
My Daughter	9/4/2007
Q: I have Medicaid and Medicare,I'm getting Custody of my 3 year old Girl,will she be Covered by My ... A: She will not be covered by Medicare. The regulations are different in every State with regard to ...
coverage	9/3/2007
Q: 1.If a US citizen(me) move to Canada and buy a house, do I qualify for Canda health care? 2. If I ... A: Sorry about the delay. I thought I had answered this but the system advised today my answer did not ...
HMO Medicare combo	9/1/2007
Q: I am marrying a 65 year old man who (is wonderful and..)has Secure Horizons and Medicare. When we ... A: He does not have to change insurances. If his present insurance is part of a retirement package and ...
changing insurance	8/30/2007
Q: I have MS and I am on medicare and have my own insurance. It is a PPO. They covered my ... A: You could request the doctor to write a letter explaining the need for the drug and file an appeal ...
No Medicare Part B coverage in Michigan	8/29/2007
Q: Pedit...After a 3 week illness in hospital our Mother passed. We discovered she had never enrolled ... A: Suzanne It is common practice for providers to keep submitting claims in hopes they will be ...
hi	8/25/2007
Q: "went to a doc in ny for initial visit doc drew blood and also gave b12 shot and total visti time ... A: Very interesting. You my have received a Explanation of Benefits form from Medicare or will get it ...
Medicaid lien	8/24/2007
Q: My mother, a Washington State resident who was receiving Medicaid assistance, recently died. I also ... A: Richard Each State has different recovery laws. I am in Michigan and do not know the laws there. ...
hmo problem	8/15/2007
Q: My father's insurance company cancelled him in February 2007, but never informed medicare of the ... A: It really is the responsibility of the insured to notify Medicare when there is a change made. This ...
lap band surgery	7/31/2007
Q: i was approved for lap band surgery in dallas,tx. they notified me that my september appointment ... A: Brenda To the best of my knowledge, there is no such requirement. However, sometime one of the CMS ...
Georgia Medicaid	7/31/2007
Q: I'm hoping that you can lead me in the right direction. I have pulmonary fibrosis, Rheumatoid ... A: Andrea Sorry, but I will not be of much help. Medicaid: I am in Michigan and the regulations for ...
turning 65 Aug 13 HMO vs PPO vs other choice	7/25/2007
Q: I am working full time, currently have coverage from former employer, American Express Retiree ... A: Shirley Information you are giving me about the PPO just does not make sense. There is a ...
home sale and medicare	7/19/2007
Q: My question is this. My mother moved in with us in 2/06. Her home was for sale, as she was not ... A: It would take a long time to explain the. Check with the local Area Agency on Aging. Basically the ...
home sale and medicare	7/19/2007
Q: My question is this. My mother moved in with us in 2/06. Her home was for sale, as she was not ... A: When you are talking about the house and going back 3 years, you are talking about Medicaid,,The ...
home sale and medicare	7/19/2007
Q: My question is this. My mother moved in with us in 2/06. Her home was for sale, as she was not ... A: Shelly The regulations for Medicaid are different in different States.However in all probability ...
Medex Gold and Drug Coverage	7/17/2007
Q: My mother is 85 yrs old. She has had Medicare Part A/B and Medex Gold for years. She did not take ... A: Norm Am not familiar with [plans on Massachusetts. However, if she is in a nursing home she is ...
Medicare	7/12/2007
Q: My husband is 18 mos older than me. When he starts Medicare @ 65 and is still working, can we just ... A: Liz Glad you asked. One or two months before he is 65 he should go to the local Social Security ...
Medicare Fast Track	7/12/2007
Q: My mother in law is 62 years old and will be 63 in March 2008. Her husband is retired and covered ... A: Yolanda There is no fast track for her to get Medicare coverage. It is 2 years away. If she is ...
state of washington medicaid question	7/4/2007
Q: i'll try to make a long story short..my husband recently got social security disability, well the ... A: Sorry. I cannot be of much help. The two year wait is firm. With regard to Medicaid. Each State ...
Medical assistance in Ohio	6/27/2007
Q: My new Husband has a Aunt and Uncle that live in Ohio, he has had a stroke, the hospital has asked ... A: Trish Sorry. I am in Mich and not familiar with Ohio rergulations.Usually, case like you have ...
Look-back medicare	6/25/2007
Q: I understand they changed the look-back law, from 3 to 5 years . In sept 2005 we put my mom's house ... A: Bill Each State has different regulations and sometimes differet interpurtations of the law. So ...
Medicare enrollment	6/25/2007
Q: I'm trying to help a woman get on Medicare. To put it mildly, Medicare's web and phone things don't ... A: Steve You have been attacking the windmill. Correct method is to go to the nearest Social Security ...
overpayment	6/23/2007
Q: My husband is disabled, and on medicare (but didn't realize it was automatic) he was in a work ... A: Sally What is the Medicaree start day shown on the Medixcare card? Does he still have the ...
Billing Medicare	6/22/2007
Q: I am trying to gather information for my grandson who would like to pursue a career in providing ... A: Judy Just off hand I do not know the procedure. However. there are three ways to find out. Call ...
Alzheimers	6/13/2007
Q: My friends mother is not doing very well mentally. She has been diagnosed with Alzheimer. Can you ... A: sherry What State are you in? The regulatiions vary in each State. IN GENERAL: sPOUSAL ...
Medicare services	6/11/2007
Q: My mother is quite ill at this time and needs home care and we've been told that medicare will not ... A: Lewanda There is a lot of emotional issues in your question that I can not address. Home health ...
Doctors	6/6/2007
Q: I live in Rome Georgia and know that Medicare and Medicaid will pay for the Bariatric surgery that I ... A: emma I am in Mich and do not know your area. Suggest you ask you case worker for a list of doctors ...
medicaid	5/28/2007
Q: I have just received my medicaid card but i found out that i was moving from nc to florida within ... A: This was sent to SPAM by error and I just found it. Sorry for delay. Medicaid regulations differ ...
parents ins	5/27/2007
Q: my parents switched from medicare to kaiser ins as primary can they switch back to medicare as ... A: Holly They will be able to switch after the 15th of October with a start date of 1 January. They ...
Medicare & Hospice	5/22/2007
Q: If a person on Medicare has terminal cancer and needs Residential Hospice, will Medicare cover the ... A: Barbara Sorry. Not real positive about this. I believe it will not. Ask this question with the ...
medicare advantage problem	5/13/2007
Q: As of Dec. 2006 I rec'd medicare A & B due to a disability. I called BC/BS a few times to be sure ... A: Paula Check the plan out. A Call 1-800-Medicare and request info on plan B Or go to Medicare.gov. ...
medicare advantage problem	5/11/2007
Q: As of Dec. 2006 I rec'd medicare A & B due to a disability. I called BC/BS a few times to be sure ... A: Paula Sorry===more questions. There is more than one type of Advantage plan. Do you know which ...
I'm pregnant with medicaid and moving states...	5/10/2007
Q: I'm currently pregnant with my first child and had to enroll in the medicaid program. I'll be ... A: Stephanie The regulations regarding enrollment are different in each State. Most States require ...
insurance	5/9/2007
Q: I have recently become unemployed. I was on the company policy for 14 years. I have no health ... A: Jack As far as new insurance is concerned, you have to deal with a local agent and get best price, ...
Medicare & Cobra	5/2/2007
Q: John, I turned 65 yrs. old Feb.2007, I enrolled in Medicare A, Dec.2006 when I was told I had to. ... A: Bob You enrolled in Medicare in DEC 06 with a start date of 1 Feb 07. Wile you are working the ...
Breast Reconstruction after Mastectomy	4/21/2007
Q: My mother lives in S.E. Georgia and has recently been dx with breast cancer. She has been advised to ... A: Clyde All is not lost. The HMO is still Medicare, just s different way of paying. Still up to the ...
Breast Reconstruction after Mastectomy	4/21/2007
Q: My mother lives in S.E. Georgia and has recently been dx with breast cancer. She has been advised to ... A: Clyde If she does not have Medicare, then indeed it is your responsibility to get the answer from ...
Medicare Qualification	4/20/2007
Q: You helped me once before (previous q&a below) and again I would appreciate you advice. Date: ... A: Susan Hi Bad news. If you had taken the disability back then you would be eligible for Medicare. ...
Medicare C	4/18/2007
Q: Medicare C, from what I understand is Medicare Choice or Advantage, a managed care program for ... A: Chanty Part C and B are the basic parts of Medicare, and because of gaps of coverage, deductables ...
Help with In-laws Medicare	4/17/2007
Q: My In-laws are elderly and until this year, had Aetna insurance through his company he retired from ... A: Amy We are getting there. It appears that the problem is with the info in the master computers at ...
Help with In-laws Medicare	4/17/2007
Q: My In-laws are elderly and until this year, had Aetna insurance through his company he retired from ... A: Amy Whereabouts are they in the State? What information did the State Medicare website give you? ...
medicare	4/15/2007
Q: Can I get supplement ins, through my husband's blue cross of Florida, if I have medicare. A: Susan Yes you can if you have no other coverage. If your husband is still working and you are on ...
Eligible for Govt. assistance with insurance...	4/6/2007
Q: My husband and I had our first (and so far only) child with insurance coverage through a past ... A: j. h. I am a little weak in this area. I missed the training on this subject because of surgery. ...
Dental Implants	4/5/2007
Q: My son, age 49, is disabled. He has a history of seizures. A full upper denture has been ... A: Dorothy Sorry, but inplants are not covered in this situation.. Most States have detists that will ...
medicare and Copra	3/28/2007
Q: My 51 y/o husband is disabled from work and is on Medicare and Atnea. He will sever ties with his ... A: Trish From your information I get the impression that you and the children are not included in his ...
medicare and Copra	3/27/2007
Q: My 51 y/o husband is disabled from work and is on Medicare and Atnea. He will sever ties with his ... A: He can do better; NEED MORE INFO. wHAT STATE ARE YOU IN AND DOES HE ALREADY HAVE PART B mEDICARE? ...
medicare question	2/27/2007
Q: we have received denials from medicare and have tried everything to correct our billing error, even ... A: Need more info. What State are you in? Are you in a HMO or original Medicare? Is you insurance ...
Medicare Supplemental Ins	2/17/2007
Q: My husband has had 2 TIA Strokes and has been denied coverage with AARP's (United Healthcare Plan) ... A: when he gets Medicare next year. it appears he will be dropping the plan he has now. Make sure ...
To Medicare B or not	2/13/2007
Q: I am 49 just received my SSDI award letter. I was eligiable for medicare starting Jan.07. I have ... A: You could use 2 publications: Medicare and You 2007, CMS #10050-20 and You Guide to Prescription ...
To Medicare B or not	2/13/2007
Q: I am 49 just received my SSDI award letter. I was eligiable for medicare starting Jan.07. I have ... A: A little tricky. Does you plan have prescription coverage? If so find out if they will issue you a ...
Medicare coverage in Canada	1/17/2007
Q: Pedit, We sometimes visit our daughter in Calgary, Canada from time and always purchase travel ... A: aha maybe good news Medigap plan C with Blue Cross in Mi is $90 a month. My guess is that you ...
Medicare/Humana/Medicaid	1/9/2007
Q: My sister is totally blind. She has medicare/humana and medicaid. Because of her handicap she cannot ... A: She is a dual eligible and should be eligible for extra help. See if her case worker has passed ...
Medicare denies claim	1/6/2007
Q: I have the following health insurance converges: - Medicare parts A & B - United Health: Medicare ... A: Kaiser evidently did notexplain things to you. In October you should have received a letter from ...
Provider question	12/28/2006
Q: This is very helpful. 1. I am retired, but continue the (non-HMO) insurance (GHI)I had when ... A: He will go on the CMS provider list. It is a master list and while it will appear on the ...
Provider question	12/28/2006
Q: I am about to turn 65 and go on Medicare. I see a psycologist who has mostly young patients, none ... A: It would be unusual for him to become a provider and then deny service to other Medicare patients. ...
Medicare vs. COBRA Insurance	12/19/2006
Q: I ha ve been on disability since 2001. I receive Medicare A & B. I've been divorced for the past ... A: Easiest way is to Get a Medigap plan, like plan C or F. You will find that all the gaps in health ...
Health Benefits - Pregnant and changing jobs	12/11/2006
Q: My wife is currently pregnant and is about to change jobs. Her new job will have full benefits and ... A: Sorry. Can not help you with the FSA, just not that familiar with them. Pregnancy is usually ...
Medicare, Medicaid & Kaiser Permanente	12/7/2006
Q: My son is a member of Kaiser Permenante and has the Senior Advantage program (although he is only 38 ... A: Depending on the State you reside in, the bills are probably legit. If you tell them you will pay ...
advantages of an HMO over a Medigap policy	11/14/2006
Q: my neme is Carlo i am 65 years old and I purchased a Medicare Part B policy but i am still concerned ... A: Call 1-800-Medicare and request a copy of Medicare and You 2007. With an HMO you must use the ...
medicare and nc teachers insurance	11/7/2006
Q: My grandma is currently on Medicare and NC state teachers insurance. We are wondering if it would be ... A: the teachers is supplemental to Medicare and she needs it to make sure everything is covered. She ...
Medicare and dental	11/2/2006
Q: John: In response to your answer: Marsha does not have liability insurance and is not covered by ... A: Sorry, I was out of town. The liability insurance would be from the City of Honolulu. You should ...
Moving out of state with Medicare	10/29/2006
Q: My mother is 53 years old, and she is quadrapeligic due to muscular dystrophy. I have cared for her ... A: Because the Medicaid laws are different in each state, I cannot be of much help. The info you need ...
Parents over insured?	10/28/2006
Q: Dad is 80 with some health issues. Mom is 79 with alot of serious health problems. Their 1st ... A: From the information given I assume his retirement HMO is no a Medicare HMO. Check it carefully and ...
Medicare for "Adult Child"	10/27/2006
Q: I am 21 years old and was under my father's health insurance because I was a full time student. A ... A: Go tto Benefits.com, enter the information requested and you will get a list of things you are ...
Medicare and dental	10/24/2006
Q: In Oct 2005, I was injured in a trip and fall in Hawaii. When I tripped, I hit my mouth on the ... A: You will need a lot of time and documentation. Was the fall covered by any liability insurance. If ...
medicare, medicaid and medicare advantage plans	10/6/2006
Q: I just moved to Maryland and have medicare A and B and medical assistance (medicaid). Is there any ... A: You have no need for an Advantage Plan or a Medigap Plan. You are a dual eligible(Medicare and ...
Medigap Ins. --2 policies--Do I Keep,or drop 1 ?	9/30/2006
Q: My Mother is 85, in a nursing home with alzheimers disease--she purchased aarp Gap Ins.7-1-87, then ... A: No. As a matter of fact, it was illegal for the BC salesman to sell you another Medigap policy. If ...
How to get bills paid if I have other Health Insurance	9/27/2006
Q: Can I file the claim with Medicare Dear john, my wife is disable and recieves Social Security ... A: See if the provider will file. They have all the paperwork and right claim forms. You can call ...
gastric bypass and medicare and blue advantage	9/6/2006
Q: I am a 49 year old male on SSDI. I have Medicare part A and am on BC of Louisiana thru my wife's ... A: Sorry for delay but I was out of town. Not sure what you mean by GBP. I am in Michigan and do ...
Voluntarily drop HMO for Medicare?	8/31/2006
Q: My 94-year-old mother is moving to an Aegis Assisted Living facility in California. They have a ... A: One of two ways/ Call 1-800-434-0222 anf tslk with my counterpart in California. Go to ...
Medicare supplemental insurance	8/18/2006
Q: My cousin lives in California and is covered by both Medicare and a Blue Cross HMO supplemental ... A: I am in Mi and am not sure about PA laws. However the answer is probably yes. Have the family in ...
Medicare coverage	8/17/2006
Q: Yes, this area does have a Medicaid Waiver Program. As for the VA, he didn't retire. I believe ('m ... A: OK. To contact my counterpart in Florida call 1-800-963-5337for assistance. They can help you get ...
Medicare coverage	8/17/2006
Q: We are in Crestview, FL.My grandfather is 84. He has recently had some health issues which makes me ... A: I am in Michigan. So. Hate to do this but. Call up the nearest Area Agency on Aging(AAA) and ask ...
I was put on hmo private medicaid	8/2/2006
Q: I have worked since I was 18 years old and I am now 39 years old through the years I have had ... A: That is one heck of a question. Youy will certainly have problems gettingcommercial insurance. ...
What is Medicare C?	7/30/2006
Q: I am about to go on Medicare A and B, a medigap policy (GHI-Blue Cross-Blue Shield) and a ... A: There used to be only A and B. Then cams C which was the Managed Care plans under the Medicare plus ...
Medicare Question	7/26/2006
Q: Sorry. i should have given more detail. As a retired City University (NY) professor, I, and my ... A: With Medicare part A and B. you have basically the same coverage of the GHI and BC combined.Most of ...
Medicare Question	7/26/2006
Q: I'm a retired professor about to turn 65. I have (from my former employer) Blue Cross and GHI ... A: Could give better answer if I knew: What state you are in. When you turn 65. What kind of ...
ssi	7/11/2006
Q: i am now recieving ssi, i am 62 will be 63 in december, i would like to know if my income from ssi ... A: Question is really unclear. However, you will not get Medicare until you are 65. You can get ...
Medicaid	5/25/2006
Q: Our parents are in nursing homes and receiving Medicaid in Michigan. They lived rent free in a ... A: Go to the case worker and request a hearing. If necessary go to the supervisor. Request a hearing ...
Family Health Care	4/30/2006
Q: I am on Medicare. If I turn my medicare benefits over to a HMO care provider and join their plan, ... A: If your present coverge is employer or union related, I need to know> I suspect you are on original ...
What is Medicare C	4/24/2006
Q: Just curious. I've often hears about Medicare B and Medicare D, but i've never heard anything about ... A: part C is the managed care section of Medicare. Came into beung abou 6 years ago and was called ...
cobra or private insurance	3/13/2006
Q: My husband is going to take his retirement from a city job that provided us with good medical ... A: In cases like this COBRA is often the best way to go even if it is expensive, Check with his ...
medicare B & D	3/1/2006
Q: and thank you for your service. I live in Michigan. I was determined totally disabled and in May ... A: Suggest you contact SS and get part B ASAP. You can get a Medigap plan C from Blue Cross for $90 a ...
Medicare for Seniors	2/14/2006
Q: My mom is a widow who has Blue Cross Blue Shield medical coverage and Medicare. Has the Medicare ... A: Other than perscription coverage nothing has changed. I have a hunch she has a Medigap policy, plan ...
follow-up	2/4/2006
Q: I'll follow up with SHIP. If it's not too much of a bother, there are a couple of issues that, ... A: For coverage purposes it is the actual date of service, even if preapproved. As far as the ...
Medicare HMO/PPO non-emergency transportation	1/7/2006
Q: (scroll down for follow-up please) I am a 36 y/o disabled female on SSI and "dual eligible" ... A: I am well aware of Advantage plans, I teach new counselors on them. Most people do not realie that ...
Medicare HMO's with little cost to patient -- how do they do it?	11/10/2005
Q: I have been insured by a Humana medicare supplement (gold value plan) since retirement. I am 74 and ... A: Your are in one of two situations. 1. You are in original Medicare where for the most part ...
Medicare Part D	10/30/2005
Q: I am trying to compare multiple Part D plans in my state (AZ). Some of the plans have the drugs I ... A: Sorry. Can not help you depends on which state you are in. Any tier over the standard tier will ...
medicare eligibility my rights	10/23/2005
Q: -I am in Raleigh,North CarolinaThis is a long question so please be patient with me. I have had a ... A: Call 1-800-443-9354 and you should getmy counterpart in NC, who knows that area of the country and ...
Long term care insurance	7/20/2005
Q: My wife's grandmother recently ended up in a nursing home and her estate is quickly being spent. ... A: This is a hard decision to make. You have to take several things into consideration, weigh each and ...
Health Insurance	5/1/2005
Q: I am 68 and my wife is 62. We are both covered through my university's health plan. I'd like to ... A: Hard to answer since I do not know how your policy is written. But you have at least three or four ...
mediciad	4/21/2005
Q: I am High School student, currently inrolled in a government course dealing with public policies. ... A: Medicaid is a state run program and each state has different regulations. Your best bet is to go on ...
Insurance Coverage	3/29/2005
Q: I currently have health insurance through my job. I am currently on dialysis. I am looking for ... A: The insurance that you have now and that you would have under COBRA is deemed "creditable coverage" ...
Medigap	3/8/2005
Q: I'm a 68 year old college professor with plans of retiring in two years (May, 2007). I have ... A: You have part A so that is not a problem.You do not need part B as long as you are working. After ...
Medicaid Spend-Down Amount	12/18/2004
Q: What are the allowable expenses to achieve the spend-down amount for Medicaid? Does it include home ... A: That is hard to answer because Medicaid is run by a State Agency and every State has its own laws. ...
Medicaid Insurance for the elderly in Ohio	11/21/2004
Q: My mother in law lives with us. She is 66 yrs old and has a very small SS ck of just over $500 per ... A: The states all run their own Medicaid programs. I reside in Mich and therefore am not knowledgeable ...
Effective Date of Medicare	9/8/2004
Q: If my birthday was on the 1st day of the month, April, what is my effective date of Medicare ... A: It depends. If you were already receiving Social Security [ropr to April, it would start the 1st of ...
medicaid and bankruptcy	8/25/2004
Q: I have an aunt that is totally disabled with no job but has been "given" credit cards by credit card ... A: Financial planning we can not go into. But in regard to Medicaid, when she receives the inheitence ...
COBRA Question	6/24/2004
Q: I am currently on COBRA and wish to switch to a new plan outside of my old employers insurance. I ... A: The protection from HIPPA is for preexisting conditions. There is no equirement that they accept ...
Picture I D	6/9/2004
Q: I have an adult daughter and two other adults that I'm a care giver for. All three are ... A: Unfortunately I am in Michigan, so I do not know the answer. However, each state has it's own rules ...
health coverage	5/24/2004
Q: I suffer from chronic depression and haven't been able to work for years. I qualified for disability ... A: Yiu goofed by not taking the disability. You will have to contact Social security to see if they ...
Medicare Part B - can one be forced onto it?	5/21/2004
Q: My husband is disabled and has been covered for 12 years by his primary LTGH insurance company which ... A: Tough question. It all depends on whether he is an employee of Atena or not. That is a legal ...
Medicare	5/3/2004
Q: No he has not been employed for two years --out on Social Security disability and yes, Qualify for ... A: OK HIM--He does not need Blue Cross. Medicae covers part A. Part B seems to br covered by the ...
medicare and medicaid controversies	4/28/2004
Q: Pedit. My name is Brad, I am a senior in high school and am participating in a debate about ... A: Boy did you ever pick the wrong time for a debate on Medicare and Medicaid. Both are scheduled for ...
supplemental insurance	2/18/2004
Q: I have medicare, and i recently picked up blue care 65, which is suppose to pick up the remainder of ... A: Are you in Mich and was you dropped by M-Care? John The reason I ask is that if you are in MI, it ...
supplemental insurance	2/11/2004
Q: I am 51 years old and a quadraplegic due to a working accident. I am currently on Medicare A and B ... A: Modt of the stuff you mentioned is covered by Medicae. Ask the durable equipment provider you are ...
Caring for an elderly family member	8/4/2003
Q: Doesn't Medicare compensate a family member who is the primary caregiver for their Medicare ... A: Medicare does not. Medicaid on the other hand may. Check with the social service agency in your ...
Medicare	5/27/2003
Q: first, I want to thank you for volunteering your expertise and I hope my question is within the ... A: Tell me'' As one retired military to another it appears that you and i are both SOL when it comes ...
i am trying to gather information on problems with hmo's for a class assignment	2/25/2003
Q: i was wanting to know why some hmo's don't supply their patients with the right medical treatment if ... A: WOW? You are asking a lot. It really depends on the contract. If it id a Medicare HMO the regs are ...
medicare	2/22/2003
Q: I understand that medicare has a $100 deductable each year and also understand that medicare will ... A: Soory. The deductable is based on the Medicare approved amount. Since it is not covered, there is no ...
HMO Referral	1/28/2003
Q: If a patient has an HMO as a secondary insurance, will the HMO pay as the secondary payer without a ... A: Being in an HMO you must follow their rule and regulations.If it is a Medicare HMO the rules are ...

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