I am a 72-year-old woman from North Carolina, recently diagnosed with breast cancer. I will start chemotherapy soon. I have medical insurance through my wife’s job, but they are denying all my claims, and many more are coming.
Their reason is that I should have Medicare Part B. However, Medicare says I don’t need it since I’m over 65 and covered by her insurance, which is from an employer with more than 20 employees. They should be my primary payer.
I have contacted the insurance company multiple times, but they just give me excuses and do nothing. What can I do to resolve this before starting chemo? The bills are already $50,000, and it’s only going to get worse.
Please advise 
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Get a copy of the exact insurance plan from the employer and check the coordination of coverage/benefits section.
Also, call the insurance company to verify the details. If the employer coverage is considered creditable, you should be fine. Escalate the issue and ask to speak with a senior manager.
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I will ask her HR to get me a copy. Her insurance is creditable. I have talked to the insurance COB. Worthless. Next I guess is the Senior Manager.
Thanks
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You have to have part B. You are over 65. That’s how it works. I’m sorry but it does.
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This happens a lot with Aetna plans. They often say, “You need to sign up for Medicare before we’ll pay anything.”
It could also be that they want Medicare Part A billed first and will only pay after a denial, so make sure to check that.
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That’s where things get crazy. Why would I pay for both? They will not bill Part A because Part A is only for hospitalizations not outpatient.
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My practice still bills Part A for a denial to send to Aetna, as some plans require it.
Aetna’s UN PPO plan will calculate your benefits as if you’re enrolled in Part B, even if you’re not, meaning you’ll have to pay the amount Part B would have covered.
In my opinion, most Aetna plans aren’t good.
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Wow. I hope this is not the case. My medical will not even bill Part A. They are behind me trying to make Cigna the primary payer. What is UN PPO?
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It’s a lot of jargon that doesn’t really matter.
You’ll need to keep calling your insurance’s coordination of benefits line to sort this out, as every plan is different. I can’t tell you the exact issue, but I can explain the possibilities. Unfortunately, insurance companies often make their own rules. I’m sorry it’s so frustrating.
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Yes it is a mess. They do seem to make their own rules when it comes to paying.