Thursday, February 27, 2025

Insurance Issues

Shortly after the beginning of the year an official-looking envelope from my health insurance company showed up in the mailbox. When I opened it there was a letter that said that as far as Medicare was concerned I may have had a gap in prescription drug coverage for several months in 2024.

I knew that wasn't correct. Hubby Tony has good retiree insurance (which includes drug coverage). Each time I picked up a prescription all I had to pay was a small co-pay.

The letter said “If you did have prescription drug coverage you may be able to avoid the penalty by returning the enclosed form”. I filled out the form and took it to the post office the next day. Before I put the envelope in the slot I took a date and time stamped photo so I had proof.

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A month later I received a second letter that was identical to the first except for the deadline, which had been pushed back two weeks. As I had already mailed the information, I called the number listed on the form for guidance. I was told by an associate that there was no need to send it again.

This week I was quite upset to receive a third letter. It said that Medicare had determined that because they hadn't heard from me they were imposing a Part D (prescription) late enrollment penalty.

WTF!

I don't know if the insurance company or Medicare dropped the ball, but either way the outcome was unacceptable.

After spending some time yelling and screaming, I got busy proving them wrong. I filled out the Part D Late Enrollment Penalty (LEP) Reconsideration Request Form. Tony went to the health insurance website and downloaded a copy of the IRS document 1095-B which showed I was covered for the entire year. I also downloaded the details of my 2024 prescription claims and included that spreadsheet.

The documentation was to be sent to a third-party compliance company. I doubt that the person who opened the mail there would care about my predicament, but I also wrote a cover letter that included the details about the first two communications.

This morning I walked up to the post office, where I paid for a Priority envelope so I would have proof that it was delivered. Now I get to wait and see if they try to give me the runaround.

Five years ago today: If You Can't Find It New, Make It From Old

27 comments:

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    1. Thanks. I think I'm going to need all the luck I can get.

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  2. Incidents like this stress me out and make me sad!!
    I hope your problem is solved soon!

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    1. Thank you. I hope there's a quick resolution too.

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  3. Oh Kathy these situations frustrate me so. I'm glad you had all your ducks in a row and can prove things as you've explained. We went through an 18 month nightmare with something like this. I hope this all works our quickly!

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    1. Thanks for your encouraging words. Now is not a great time to deal with anything government-related.

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  4. I think the government workers that might get fired don't give a hoot right now.

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    1. I agree. However, I have my fingers crossed that I might find the one who does.

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  5. These things drive you to distraction, don't they?

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  6. Are you certain that the letters you received were from Medicare and not a fraudulent operation set up to look like Medicare? We have dual coverage and have never had to produce any documents for Medicare to show that coverage.

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    1. The original correspondence came from the secondary insurance company, and included phone numbers that I was familiar with.

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    2. I missed the part about it being from YOUR insurance company. That is also strange. The insurance companies usually stay on top of this dual coverage so as to not have to pay a cent. Hope you can get them to see clearly that you are covered by Medicare and all is well with your prescription costs.

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  7. Oh no, keep us posted, very stressful.

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  8. That is awful, makes me mad. I've had things like this happen.

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    1. I guess I'm fortunate not to have the issue before.

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  9. Yikes. Not fun.
    PS: Read your comment. Glad you're on the mend.

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  10. It will work out. It is frustrating to deal with this type of issue but since you have all your documentation it will get resolved.

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  11. I know this is so frustrating for you...Not sure who is messing up, but I know that a lot of our issues is the mail system. I mailed our form to the comptroller for 2024, the day after I got it (which was the first of December). I never received any communication until the day after it was due..(January 20th) saying they had not received it....ended up costing me money for a late fee, which definitely could not have been late. Maybe just a way for them to make more money. Hope you get this issue solved and that it comes out in your favor. Happy March.

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    1. I hadn't thought about it being a post office issue!

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  12. So very sorry you are having to deal with this!

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  13. OH noooo... This is awful! I'm feeling terrible just thinking of the headache you're going through.

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