Mr. D was denied coverage for non-emergency ambulance transportation.

Problem:

Mr. D recently returned home after being hospitalized with a number of severe medical conditions, including end-stage renal disease. Mr. D requires dialysis three times a week. His family contacted a local ambulance company to request regular appointments for transportation to the dialysis facility, because he is confined to his bed. The family also forwarded a letter from Mr. D’s doctor stating that this transportation was medically necessary because Mr. D needs medical services during your trip that are only available in an ambulance. However, the ambulance company refused to transport Mr. D because it said that Medicare would not pay.

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Mr. D was worried that his father-in-law might need Part B to cover rehabilitative care in a nursing facility.

Problem:

Mr. D’s 82-year-old father is still working and has insurance through his job. So, he turned down Medicare Part B. He did enroll into Medicare Part A. He was recently hospitalized and then sent to a skilled nursing facility (SNF). Mr. D discovered that his father’s employer policy had very limited coverage for SNF care. Mr. D became concerned that his father would need Part B in order to get the care he needed.

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Mrs. B’s gynecologist did not accept assignment and refused to bill Medicare.

Problem:

Mrs. B’s gynecologist took Medicare but did not accept Medicare assignment. Doctors who do not take assignment do not have to accept Medicare’s approved amount as payment in full. They can charge up to 15% above the Medicare-approved amount for their services. They can also ask their patients to pay for services up front. Mrs. B was paying her gynecologist up front. Medicare had never reimbursed her for the service. Mrs. B called Medicare to find out why she had not been reimbursed and found out that her gynecologist had never submitted a bill to Medicare.

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Mr. N was eligible for a Part B Special Enrollment Period through his domestic partner.

Problem:

Mr. N is 50 years old and had Medicare Part A due to a disability. He declined to take Part B because he had his primary insurance through his domestic partner, who worked at a company with more than 100 employees. Recently, his domestic partner found a new job. When Mr. N tried to enroll in Medicare Part B, during his Part B Special Enrollment Period (SEP) Social Security told him he was not eligible for a Special Enrollment Period because his insurance came through a partner, not a spouse. He was also told that he would have to wait to enroll until the next General Enrollment Period (GEP), which goes from January through March of every year with coverage beginning in July.

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Medicare paid for Ms. B to have her teeth removed but would not pay for dentures.

Problem:

Ms. B has oral cancer and needs radiation therapy to treat it. Her teeth are not healthy, and her doctor wants take them out because they may become infected during the treatments. Her doctor told her she would need dentures before her radiation treatments so she could eat and maintain her health. Medicare covered the cost of removing her teeth but denied her coverage for her dentures. Ms. B could not afford to pay for them herself.

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Medicare mistakenly told Mr. S that he was entitled to a Part B Special Enrollment Period.

Problem:

Mr. S had health insurance under his wife’s retiree group health plan.

Mr. S enrolled in Medicare Part A when he turned 65 and was told by an 800-MEDICARE representative that he did not need to enroll in Part B at that time since his wife’s retiree plan sufficiently covered his needs. He assumed he could enroll in Part B without penalty when and if his wife’s retiree coverage ended.

When his wife’s retiree coverage ended, he tried to enroll in Part B. Social Security informed him that he would have to wait to enroll between January and March during the General Enrollment Period and be without Part B coverage until the following July. He would also have to pay a premium penalty for late enrollment.

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