Dual/Tri Medicare Coverage for 15+( Where to begin?)

[medsuptage]

Hey guys,

I have a client who, unknowingly, has been double paying " United Health Group" ( a subsidy of UHC) for about 15 years now. she started medicare in 04, had at the minimum 'United Health Group" (UHG) for 3 years. Then she enrolled in Texan Plus HMO MA and continued on paying UHG for 10 years.... When I called her here recently to roll her med supp, we both figured out why everything was so expensive, she currently has Part B, UHG at $260ish per month and a med supp at 160ish per month... and part D.. UHG has been quiter than a mouse not mentioning a peep as they continue to stick their hands in her bank account every month for the last decade and a half.

I've had her supplement for about 4-5 years, and before me she had had texas plus for 10 whole years. So she's been dually covered by UHG for a miniumum 14-15 years. She can't remember, I don't blame her, I probably wouldn't either, if she had anything additional too UHG when she started medicare A&B or not.

Two issues:
1. Not sure how to find out for sure if she was dually covered the first 3 years she was on Medicare or not... Not sure how to go about finding out. (Checking Medicare.gov, with her information, it only shows UHG covering here uninterupted sincd 2004, and then Texan plus kicking in around 2007. UHG is showing having started and is still pressing on today. UHG is actually listed twice as covering her uninterupted, she doesn't think it's employer coverage or anything like that, Medicare doesn't provide anything in the way of details on their site. Is there any way to find out for sure if she's due back premiums from 2004-2007, without just hoping UHG is going to be honest. Considering they've been hiding in
the dark for 15 years cashing checks, not mentioning a peep, I doubt they'll be helpful here.

2. I know she's due atleast 15 years in back premiums from UHG, how do I go about helping her reccover all that money? Who do we. I, her. us? call? That's like 60 grand in premiums she's due, at the bare minimum... She's paying UHG like $260 a month today, never used them for a single claim, only used medicare and her current supplement. She JUST stopped the payment on UHG, but isn't sure where to start in recovering the premiums. She's tried called, we faxed in a request to recover her premiums and haven't recieved anything, no calls no emails, and that was coming up on 2 weeks ago. What do we do, to help this woman get her very much due, back premiums? I don't even know who to lean on.. It's not MA, but Medicare does list it as covering her but doesn't reference it as a Med supp or MA, frankly I don't know what "type" of coverage it is, it doesn't say, and she hasn't used it so she's not sure either. All she knows is she's paid them a fortune.

Any assistance in helping her would be greatly appreciated. This is so unforunate, she's been having a hard time getting by, and she thought she was "paying Medicare" this whole time.

Thank you very much for any insight you guys & Gals can assist me with.

 

[GoPokes]

If you REALLY want to to get to the bottom of this, just go to the state insurance department. They can find probably tell you who it is. As far as back premiums go, good luck, it may work out, but I wouldn't promise the lady too much. Set proper expectations.

I found a lady recently, she had mapd and medsupp. I thought, oh she can get some back premiums from medsupp, but the medsupp said they paid on some claims over the summer... not sure how that happens, since medicare was not primary. Not exactly in my job description to get her back premiums, she was not upset about it, so I got her fixed up and moving forward happier than before.

 

[somarco]

Checking Medicare.gov, with her information, it only shows UHG

Medicare will only show one Medigap or MA plan. If she has multiple plans they will only have one, usually the most recent one.

she's due atleast 15 years in back premiums from UHG

Yeah, good luck with that. Most carriers will only refund 12 months, and then, only begrudgingly

 

[LostDollar]

Caveat, not an agent.

The posts I have seen here from agents suggest that any carrier refunds in this type of situation are unlikely, or will be for a very short period of time if any refund can be granted.

If there is a TV news channel in her area that takes on cases of consumer mistreatment, airs details and tries to help consumer get resolution; that might be an option.

 

[medsuptage]

If you REALLY want to to get to the bottom of this, just go to the state insurance department. They can find probably tell you who it is. As far as back premiums go, good luck, it may work out, but I wouldn't promise the lady too much. Set proper expectations.

I found a lady recently, she had mapd and medsupp. I thought, oh she can get some back premiums from medsupp, but the medsupp said they paid on some claims over the summer... not sure how that happens, since medicare was not primary. Not exactly in my job description to get her back premiums, she was not upset about it, so I got her fixed up and moving forward happier than before.

I get the above occasionally too, and facts are, we're working with old folks. Their memories aren't perfect.. this stuff is not only complicated, it's boring, pared with fading memories... yeah, who knows how her supp paid claims when she was on MA,

Medicare will only show one Medigap or MA plan. If she has multiple plans they will only have one, usually the most recent one.




Yeah, good luck with that. Most carriers will only refund 12 months, and then, only begrudgingly

That's what I thought too, and I know you and I are not beginers by any means, but, and I absolutely speak for myself only, but apparently I'm no expert.. I know you and I have been playing with Medicare about the same amount of time, although I'm sure I've been MUCH MUCH more leisurely with my time off..
Check this out...




WOOPSIE, I almost forgot the best part!

AND YES, BELOW NEW ERA, there lies UHG, LISTED DUALLY, just like above, dating back to 2004

This is one single, finite profile.... Same ladys profile... I edited her plan D number out and the number after her med supp that I haven't the slightest to what ever that is referencing... other than that, those are identical screen shots of this person's profile.

I thought... Insurnace companies were bound by the law to refund insurance premiums they legally had no right too because they we'ren't even insuring plausible risk... for atleast 15 years, UHG can't even say that they were "insuring her, she just didn't generate claims." No, not true there was 0% ( okay 0% logically, if the company wants to play games and get really technical... than 1%. That's If the policy holder decided randomly to do something really stupid that made absolutely no logical sense). UHG was collecting premiums and insuring nothing but sky hooks and board stretchers.. There was no chance of a claim for atleast 15 of those years, just not certain about 2004-2007...And, don't get me wrong, I know there's some really farfetched, asinine scenarios the company could conspire to sort of scotch tape together something that barely even looks like risk, but they're all HUGE stretchs and unless money was exchanging hands under the table, no one with half a brain would buy into any of them.
So since UHG wasn't liable for any risk what so ever and was just cashing premiums month after month, aren't they required to refund that money? I THOUGHT that was the law, that insurance companies had to be insure true risk to be collecting premiums.... but every day that passes I begin to wonder what in the hell I even think I know anymore. Apparently it's not much...

Edit reason: damn near forgot the best part...

 

[TwoCents]

"I thought that was the law...." -- famous last words. I'm not sure if you're in the right frame of mind to write out a thoughtful, logical argument at this point, but you could always try writing the CEO. There might be an office who reads that mail so it could get some traction. Or like someone else suggested -- Dept of Insurance.

 

[GoPokes]

At some point the lady must accept some responsibility... it is her money, and her bank account, for which she is responsible to audit and what not. I'm not necessarily defending the insurance by any means, I dont have a dog in this fight. But I have double paid for things in the past, and I dont expect anyone else to catch it for me.

 

[somarco]

I thought... Insurnace companies were bound by the law to refund insurance premiums they legally had no right too because they we'ren't even insuring plausible risk...

I think the term you are looking for is UNEARNED PREMIUM.

Technically, the carriers WERE on the risk contractually . . . IF a claim was submitted they WERE obligated to pay it.

This is not the same as continuing to draft life insurance premiums on a dead person. THOSE premiums really WERE unearned . . . at least those drafted after death.

I am not a lawyer, and neither are you. Unlike all the folks on FB that pretend to be "Constitutional" lawyers, this is different.

I don't think you, or the policyholder, will get very far.

Sounds like she was acting on her own, no agent to blame, and probably dealing with HO critters who aren't the brightest bulbs in the box.

In all fairness, it seems like the lady would have to PROVE these carriers KNEW there were competing plans in force at the same time as theirs. Yes, I know your screen shot tells a different story, but seriously. Do you really think anyone at CMS is monitoring these things?

When I went on Medicare my account still showed I was covered under my prior group plan for something like 5 months. This IN SPITE of telling them almost monthly their records were wrong.

More recently my wife had a similar experience except her problems only lasted 3 months.