Insurance Coverage Woes

Many of us are caring for elderly parents. We care about getting them the very best in health care. A very big part of the health care equation is INSURANCE COVERAGE. One of our viewers called when something went very wrong with insurance coverage for his Mom.

Ronald Joseph is covered by Aetna in his job with a telecommunications company. Ron's Mom, Lynette Joseph, lives with him 6 months of the year so she is covered by his Aetna insurance also. About a year ago Ron started getting bills from his Mom's doctors. Bills that had been paid by Aetna going back four years. Now the bills were in collections; he was getting harrassing phone calls about them. It seems four years ago, Ron's Mom turned 65. At that point she should have signed up for Medicare for her PRIMARY coverage. Aetna would have then started paying out as her SECONDARY insurer.

Even though Ron's employer alerted Aetna to the change in Lynette's status, ie..her pending 65th birthday, the change was never made in her records.

Ron hadn't realized he should make the change for her and she didn't know either. Ron knows he should have been on top of this. But absent that, even if he hadn't been, if Aetna had been, those bills would have been kicked back right away and he would have made inquiry's, figured out what was wrong and corrected it right away.

Instead four years later Aetna figured out they have been overpaying.

And they are allowed to try and get that money back. In the Summary Requirements booklet Ron gets from his employer it clearly states Aetna is allowed to rescind any overpayments they made..thus the cascade of bills and bills in collections. Ron has spents hours on the phone and on his computer trying to get this all worked out.

At this point Howard stepped in.

Aetna came through. Aetna apologized to the Joseph family for the problems this has caused them.

Aetna will stop trying to collect on any of their overpayments.

Aetna will also work with any collections agencies and doctor's offices involved and explain that Lynette Joseph is blameless.

Medicare Coverage Resources:

Anyone who is about to turn 65 MUST apply for Medicare. Medicare will from then on be their PRIMARY insurance carrier. Any insurance they have had will now pay out as their SECONDARY insurer.

If you need more information about how to apply for Medicare you can log onto the Medicare website at www.medicare.gov or call 1-800 MEDICARE.