Medicare - Coordination of Benefits Customer Service Issues

My husband and I are facing an insurance issue despite paying a monthly premium through OPM. He is currently in a nursing home, and we've been with CDPHP in Albany, NY for about 30 years. Due to Coordination of Benefits, GHI is now considered our primary insurer since we had a previous policy with them from the 1970s. After my husband's retirement from the City of NY in the late 1970s, our policy with GHI became supplementary to Medicare B. We opted to stay with CDPHP at that time. Both CDPHP and GHI are denying claims, leaving us without coverage. While we want to switch to Medicare B, the current penalties make it unaffordable. My husband's birthday is on 3-16-35, and mine is on 4-3-42. His name is John M., and I'm Mary M. Our SSNs are [redacted]16 and [redacted]26, respectively. Thank you.

Hello, I am Richard Kessler, a retired U.S. Bureau of Reclamation employee covered by Medicare since May [redacted]. My current health insurance is through American Postal Workers Union (APWU) with Cigna Health Care since May [redacted]. My wife, Anne S. Kessler, has been on my health plan, including prior plans during my federal employment. I switched to High Option Self Plus One (Enrollment Code [redacted]) from High Option Family as of January 1, [redacted]. The issue is that Medicare is recognizing my wife as covered by Pacificare, which I have not been with for years, and is denying claims. I am requesting Medicare to update their records to reflect that my wife has been covered by APWU since May [redacted]. Thank you for your prompt attention to this matter.

I am unable to reach you at the provided number. My father has hearing difficulties, so I assist him with administrative matters. Currently, his Coordination of Benefits (COB) shows Medicare as secondary to Workers' Compensation (WC), which is inaccurate. We encountered a problem with his Part D coverage that I believed was resolved, but now a durable medical equipment (DME) supplier indicates a billing discrepancy. He has not utilized WC benefits since settling the claim. His only current connection to WC is for three prescriptions. I would appreciate guidance on how to proceed so I can represent him effectively. Thank you. - A. Clavadetscher

Good morning, I am reaching out from the Orange Ulster School Districts Health Plan in Orange County, NY. We have a couple covered under our plan where the husband holds the coverage. Despite the husband being retired, the wife plans to continue working post her 65th birthday. Medicare has advised her to enroll even when working past 65. I always believed one could postpone Part B enrollment if working beyond 65 without social security penalties. Can you confirm if she can delay Part B while working past 65 without penalty, or if enrollment is mandatory regardless of her working status? Thank you, A. Draughan

I received a letter from CGS regarding an appeal of a denied claim sent to Medicare. The letter states that additional information has been requested from the provider. However, when I contacted the Medicare call center, the employee said the appeal has been denied but couldn't provide a reason. The CGS letter requested a copy of office notes and a copy of the [redacted] claim form, which were already sent with the denial, supporting that the service was not a routine exam. Office notes, CPT code, and ICD code were provided with the appeal from the provider. When I contacted CGS, they mentioned they only speak with Medicare providers and suggested I contact Coordination of Benefits/Medicare. The number provided, 1-[redacted], led to being put on hold and then disconnected. I am seeking an explanation for why the claim was denied and why Medicare customer service representatives are not trained to assist Medicare beneficiaries like myself.

My wife broke her hip in October, and then again in November. After being shuffled between hospitals and a rehab center named Corsica Hills in Centreville, MD, we were disappointed with their care. The physical therapy department only focused on teaching basic walker techniques, causing my wife to lose weight due to unappetizing food. With the COVID outbreak, we moved her to Chestertown, MD, where she is battling double pneumonia. My son suggested asking Humana to cover daily nursing, physical therapy, and house cleaning for her recovery. Unfortunately, I can't drive her for therapy due to health issues. We desperately seek assistance. Thank you, Robert and Carmen C. Rousseau, enrolled with Humana. Contact me at 1-[redacted] or [redacted]