Federal retirees: Florida Blue denying my claim b/c I don't have Medicare

[Amethyst]

I am a Federal retiree, covered (or I was!) under the Federal Employees Health Benefits (FEHB). My insurance plan is BCBS Basic, which in Florida is called Florida Blue.

When I turned 65, I chose - as my late husband had done - not to apply for Medicare, because a) I don't receive Social Security benefits and b) I understood I would continue to be covered under FEHB, although only to the same payment limits as Medicare. Until now, there hasn't been an issue with Florida Blue paying claims.

A letter has arrived from Florida Blue, asking whether I am covered under any other health plan. It says that if I am 65 or older, I need a signed letter from Social Security indicating why I don't have Medicare. Without this letter, they will not process any more claims.

I already have several claims this year and expect more.

Has any other Federal retiree experienced this? Is the simple fact that I didn't apply for Medicare, and don't want to apply for Medicare, no longer enough?

By the way, I do have Medicare Part A. Just not Part B.

Thanks for any info,

Amethyst

 

[stedmakr]

There is probably something else in play or it was a mistake by the insurer. Suggest that you call your insurance provider and ask for an explanation if it is not already stated within the letter. The Fepblue phone number is 1-800-411-BLUE (2583)

 

[Wile E. Coyote]

It sounds to me that they just want verification what parts of Medicare you have and have not signed up for. But, please let us know what all you find out about this.

 

[grayv]

did you try to get the part B reimbursement ?

 

[Amethyst]

no, I wasn't aware that I qualified for it since I am not a Social Security recipient, and won't ever be. How would it pertain?

did you try to get the part B reimbursement ?

 

[grayv]

it only applies if medicare A + B are primary. if you did not get the reimbursement/discount, it does not apply to your issue.

 

[Amethyst]

OK. As my first post says, I don't have part B.

it only applies if medicare A + B are primary. if you did not get the reimbursement/discount, it does not apply to your issue.

 

[grayv]

OK. As my first post says, I don't have part B.

yeah, I saw that. I was hinting that asking for the reimbursement without A+B primary might mess up the system.


you have this under control, so I am out.

 

[W2R]

Yeah, I don't really understand what's happening with your situation, but I know that with BCBS Standard here in Louisiana, Medicare Part B is required to be primary and BCBS secondary. In other words, BCBS doesn't want to pay for anything you'd already qualify to be paid for by Medicare.

I'm no expert but I was under the impression that we HAD to have Medicare Part B, with BCBS Standard. Don't take my word for it; maybe would be a good idea to check though.

 

[stedmakr]

Yeah, I don't really understand what's happening with your situation, but I know that with BCBS Standard here in Louisiana, Medicare Part B is required to be primary and BCBS secondary. In other words, BCBS doesn't want to pay for anything you'd already qualify to be paid for by Medicare.

I'm no expert but I was under the impression that we HAD to have Medicare Part B, with BCBS Standard. Don't take my word for it; maybe would be a good idea to check though.

The OP is a federal retiree. Her BCBS is managed through OPM a federal agency. There is no requirement for her to take Medicare.

 

[Wile E. Coyote]

The OP is a federal retiree. Her BCBS is managed through OPM a federal agency. There is no requirement for her to take Medicare.

It's either a mistake by BCBS or they simply want some type of proof she does not have Medicare Part B. They may be confused because she has Part A. Happened to a friend of mine.

 

[zl55lz]

I am a Federal retiree, covered (or I was!) under the Federal Employees Health Benefits (FEHB). My insurance plan is BCBS Basic, which in Florida is called Florida Blue.

When I turned 65, I chose - as my late husband had done - not to apply for Medicare, because a) I don't receive Social Security benefits and b) I understood I would continue to be covered under FEHB, although only to the same payment limits as Medicare. Until now, there hasn't been an issue with Florida Blue paying claims.

A letter has arrived from Florida Blue, asking whether I am covered under any other health plan. It says that if I am 65 or older, I need a signed letter from Social Security indicating why I don't have Medicare. Without this letter, they will not process any more claims.

I already have several claims this year and expect more.

Has any other Federal retiree experienced this? Is the simple fact that I didn't apply for Medicare, and don't want to apply for Medicare, no longer enough?

By the way, I do have Medicare Part A. Just not Part B.

Thanks for any info,

Amethyst

When we were on BCBS, they would send a form from time to time asking about other health insurance/Medicare if I remember correctly.

It sounds routine. A verification from the local Social Security Office is easy to get via phone or walking in, in most cases.

Or perhaps sending a copy of the Medicare card which shows Part A only with a signed letter that you chose not to enroll in Part B? Maybe black out part of the Medicare id for security?

What might have triggered the request is that once 65, I believe all providers are required to submit the claim to Medicare first whether a person has Medicare or not, and since most fed annuitants apparently do enroll in Part B, they are just trying to verify not having it for sure.

 

[Amethyst]

Correct, and my late husband (also a Federal retiree under CSRS, and who also never took Medicare Part B) had his medical expenses paid under FEHB BCBS Basic for many, many years. We saved a lot of IRMAA costs by not taking Part B. Once you turn 65, FEHB will only pay up to the same amount that Medicare pays, so I am careful to stay within network and choose only providers who accept Medicare.

I haven't been over 65 for very long, but long enough to rack up quite a few medical/eye expenses, all of which BCBS Basic paid (except my co-pays, of course). So this abrupt "Produce a letter from SSA, or we won't pay your doctors" is a big shock.

I don't have any idea of what Florida Blue expects me to ask SSA to do. All SSA knows is "She has Medicare Part A, but not B." SSA aren't privy to my reasons not to take Part B.

I thought that perhaps another FEHB recipient in Florida (there must be lots of us) might have received the same letter. The urgency of several ongoing medical situations is making this quite stressful for me.

The OP is a federal retiree. Her BCBS is managed through OPM a federal agency. There is no requirement for her to take Medicare.

 

[Wile E. Coyote]

Of course BCBS wants you to sign up for Medicare A&B. If you do they get whatever the $13-$15k paid between you and the Feds for just the insurance policy, plus, Medicare covers 80% of whatever happens.

I am on the fence with whether I will take both. I know I have a slow moving cancer (so, that's likely going to tip me into wanting to be overinsured).

 

[Amethyst]

Their letter says nothing about wanting me to sign up for anything.

To be 100% clear, my post is not about "whether or not to sign up for Part B." Other threads exist on that topic - I don't want to start a new one.

It is about how to respond to a request from BCBS for a "letter from SSA."

Of course BCBS wants you to sign up for Medicare A&B.

 

[Wile E. Coyote]

Their letter says nothing about wanting me to sign up for anything.

I am not saying you have to.

I have been to the seminars and they encourage it.

 

[Amethyst]

zl55lz, thanks for your input. At first glance, I did think it was a routine query to verify whether I do, or don't, have other coverage.

What threw me was the request for a signed letter from SSA saying why a recipient over 65 wasn't enrolled in Medicare. It's a strange thing to ask, and I can't imagine SSA writing a letter about it.

When we were on BCBS, they would send a form from time to time asking about other health insurance/Medicare if I remember correctly.

It sounds routine. A verification from the local Social Security Office is easy to get via phone or walking in, in most cases.

Or perhaps sending a copy of the Medicare card which shows Part A only with a signed letter that you chose not to enroll in Part B? Maybe black out part of the Medicare id for security?

What might have triggered the request is that once 65, I believe all providers are required to submit the claim to Medicare first whether a person has Medicare or not, and since most fed annuitants apparently do enroll in Part B, they are just trying to verify not having it for sure.

 

[Wile E. Coyote]

zl55lz, thanks for your input. At first glance, I did think it was a routine query to verify whether I do, or don't, have other coverage.

What threw me was the request for a signed letter from SSA saying why a recipient over 65 wasn't enrolled in Medicare. It's a strange thing to ask, and I can't imagine SSA writing a letter about it.

If you sign into your Social Security Account you can generate a Benefits Verification Letter. It will say whether money is being deducted for medical insurance.

So, even though you are not earning SS I am sure you can still create an account (assume anyone with a SS number can). Mine shows all zeros as I am not collecting SS and I have not signed up for Medicare.

 

[zl55lz]

Correct, and my late husband (also a Federal retiree under CSRS, and who also never took Medicare Part B) had his medical expenses paid under FEHB BCBS Basic for many, many years. We saved a lot of IRMAA costs by not taking Part B. Once you turn 65, FEHB will only pay up to the same amount that Medicare pays, so I am careful to stay within network and choose only providers who accept Medicare.

I haven't been over 65 for very long, but long enough to rack up quite a few medical/eye expenses, all of which BCBS Basic paid (except my co-pays, of course). So this abrupt "Produce a letter from SSA, or we won't pay your doctors" is a big shock.

I don't have any idea of what Florida Blue expects me to ask SSA to do. All SSA knows is "She has Medicare Part A, but not B." SSA aren't privy to my reasons not to take Part B.

I thought that perhaps another FEHB recipient in Florida (there must be lots of us) might have received the same letter. The urgency of several ongoing medical situations is making this quite stressful for me.

Social Security has a generic form for benefits verification which they can give stating Part A effective date but no Part B and in remarks could put the reason, such as declined Part B per FEHB regulations--did not want to enroll. Or so I remember. I personally would go to the local office to make sure I got exactly what I needed. If they tried to put me off I would ask for a supervisor. Immediately.

 

[Amethyst]

I'll try that, thanks. Meep meep!

If you sign into your Social Security Account you can generate a Benefits Verification Letter. It will say whether money is being deducted for medical insurance.

So, even though you are not earning SS I am sure you can still create an account (assume anyone with a SS number can). Mine shows all zeros as I am not collecting SS and I have not signed up for Medicare.

 

[donheff]

Amethyst: I too am a retired Fed with no Part B. I was also the Director of HR for GSA, so I understand the FEHB (or once did). There is no requirement that you enroll in Part B. About 30% of Feds elect not to take Part B, and another 20+% would skip it if they understood the impact of IRMA surcharges when they retired.

But, you said that you and your husband did not apply for Medicare. If that is correct, then you are a rare bird, and I will be curious what comes out of your interaction with BCBS. Feds do pay into Medicare and, provided they have sufficient time in, they qualify for Part A for free. When we are retired and reach age 65, we apply for Medicare but elect not to take Part B. Medicare Part A (free) becomes our primary for hospitalization and FEHB covers everything else.

Unless you didn't qualify for Medicare (less than 10 years paid in), I can understand why the carrier would want you to enroll in Part A. But I have never read anything that says you MUST take Part A. You could try calling the carrier and turn the question around - ask them to show you why you must. But if you did not apply for Part A, I recommend that you do so now so things will be simpler in the future.

 

[Amethyst]

Thank you for this cogent explanation. I'm glad we have a former HR chief for a Federal agency on the forum, because the topic and its terminology are complex.

I have Medicare Part A, so it's inaccurate for me to say "I don't have Medicare." And yes, my agency's HR department had urged all career employees to apply for Part A once we turned 65, and to consider Part B on an individual basis.

I also applied for Part A for my husband; it paid his final hospital and hospice expenses.

There are some things that Part B pays for, and FEHB doesn't, but that's been discussed in other threads.

Amethyst: I too am a retired Fed with no Part B. I was also the Director of HR for GSA, so I understand the FEHB (or once did). There is no requirement that you enroll in Part B. About 30% of Feds elect not to take Part B, and another 20+% would skip it if they understood the impact of IRMA surcharges when they retired.

But, you said that you and your husband did not apply for Medicare. If that is correct, then you are a rare bird, and I will be curious what comes out of your interaction with BCBS. Feds do pay into Medicare and, provided they have sufficient time in, they qualify for Part A for free. When we are retired and reach age 65, we apply for Medicare but elect not to take Part B. Medicare Part A (free) becomes our primary for hospitalization and FEHB covers everything else.

Unless you didn't qualify for Medicare (less than 10 years paid in), I can understand why the carrier would want you to enroll in Part A. But I have never read anything that says you MUST take Part A. You could try calling the carrier and turn the question around - ask them to show you why you must. But if you did not apply for Part A, I recommend that you do so now so things will be simpler in the future.

 

[donheff]

Thank you for this cogent explanation. I'm glad we have a former HR chief for a Federal agency on the forum, because the topic and its terminology are complex.

I have Medicare Part A, so it's inaccurate for me to say "I don't have Medicare." And yes, my agency's HR department had urged all career employees to apply for Part A once we turned 65, and to consider Part B on an individual basis.

I also applied for Part A for my husband; it paid his final hospital and hospice expenses.

There are some things that Part B pays for, and FEHB doesn't, but that's been discussed in other threads.

In that case I would still call them and just tell them you have B only. If they want documentation, it states it right on your Medicare card. You could send them a photocopy by email.

 

[Amethyst]

Donheff, I just did what you suggested.

I spoke to a Florida Blue rep, who informed me that she could already see on my file that I have Part A but not Part B. She also said that she could "update" my records without my having to send any documentation.

She said not to worry about my claims not being processed - because providers will re-submit them if they are kicked back the first time. I'm not so sure about that, but for now, it appears I have provided all the info, via this rep, that FL Blue requires.

Thanks, everybody! Hope this thread may be of value to others than myself.

In that case I would still call them and just tell them you have B only. If they want documentation, it states it right on your Medicare card. You could send them a photocopy by email.