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Appealing Social Security/Medicare Decision
Old 12-10-2019, 08:53 PM   #1
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Appealing Social Security/Medicare Decision

I am interested if anyone has made an appeal to SS regarding medicare coverage and how it played out?


My situation: applied for medicare in Nov.(1 month after my eligibility date of Oct.) expecting it to be effective on Jan. 1, 2020. I met with a SHIBA volunteer a few months ago and his understanding was that a Nov. application should result in a Jan. starting date. Medicare and Social Security publish info on the web that I followed which should have resulted in a Jan. starting date. So what happens is SS back dates the starting date to Nov. 1st for Part B. I called Medicare and was told to call SS. I called SS and was told I had to file an appeal which I plan to do. This is very frustrating and is causing issues with my current medical care. I just got a letter from my insurer today denying my invoice for durable medical equipment because medicare is now my primary provider. I can't go back and unbuy things I already purchased and the prescription from my radiation oncologist was a couple months ago.


I've satisfied my max out of pocket under my FEHB much earlier in the year and was hoping to avoid additional $$ in 2019 which includes Part B premiums.


I'm wondering what my chances are of getting the start date changed to Jan. 1 2020??


Next week I will meet with a sales person to go over and sign up for a MA plan that overlays my FEHB plan. Hopefully she can tell me what to expect and have some suggestions.
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Old 12-10-2019, 09:33 PM   #2
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I have no experience with appealing something like this, but Medicare's own website seems to support what you were intending to happen. Given that their published rules are not being followed, I would think you have a legitimate defense.

https://www.medicare.gov/sign-up-cha...coverage-start
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Old 12-10-2019, 09:36 PM   #3
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Quote:
Originally Posted by MissMolly View Post
I have no experience with appealing something like this, but Medicare's own website seems to support what you were intending to happen. Given that their published rules are not being followed, I would think you have a legitimate defense.

https://www.medicare.gov/sign-up-cha...coverage-start

Yes, and the SS website also has a PDF brochure that says the same thing.
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Old 12-11-2019, 02:10 PM   #4
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I had a problem with my Medicare getting cancelled (someone stole my Social Security payments and as part of that getting straightened out my Medicare got cancelled). I went round and round with SS and Medicare trying to straighten it out but got nowhere. Finally I called my Congressman and his office got my Medicare reinstated in a day.

So if nothing else works call your Congressman's office.
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Old 12-11-2019, 03:13 PM   #5
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Quote:
Originally Posted by harllee View Post
I had a problem with my Medicare getting cancelled (someone stole my Social Security payments and as part of that getting straightened out my Medicare got cancelled). I went round and round with SS and Medicare trying to straighten it out but got nowhere. Finally I called my Congressman and his office got my Medicare reinstated in a day.

So if nothing else works call your Congressman's office.

Thanks! That's what I will do if I'm not successful with the appeal. I remember your thread and all the frustration you went through, wow!
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