I have a medical/pharmacy plan through my employer and a Medicare Advantage plan due to disability. No one can agree who pays primary.

Puffy Lux
Better water better life

TL;DR'ing as best I can from the start of this post, because the full bulleted list of bullshit is 6 pages, no lie.

Wiper Blades USA

Plan A, through my employer (currently and forseeably employed full-time), should be the primary payor on all claims, as stated by the Centers for Medicare and Medicaid Services (CMS). Plan B, a Medicare Advantage plan, pays secondary on all claims.

The opposite has been happening for two years, with Plan B paying primary and Plan A paying secondary. I only discovered this discrepancy in June, but immediately began to work to get it fixed.

Medical was fixed a couple weeks ago with Plan A and B working out who owes what to whom between themselves.

Pharmacy, on the other hand, is still broken, despite relentless hammering from myself and my HR VP, and multiple assurances from the broker that it should now be fixed. Electronic claims submitted by my pharmacy either to Plan A alone or to Plan A coordinated with Plan B are being rejected by Plan A that the primary payor needs to pay first. This -twice- is now three times in the last three business days after the broker stated in no uncertain terms to my HR VP that Pharmacy coverage was flagged as primary under Plan A, and those claims would process.

I've contacted CMS; they advised I would need to call Plan B for COB assistance. Plan B's rep says that things are configured with Plan B as primary, Plan A secondary. I called Plan A; they said the exact same thing, despite the broker's statement to the contrary. I called the Medicare Benefits Coordination and Recovery Center — they reconfirmed both Plan A and B were wrong, and Plan A should be primary in all cases.

I don't know what I or my employer can do from here. I'm not picking up any medications now until this is absolutely confirmed; I'm not going to get into a situation where Medicare wises up and then I'm wrapped up in defending myself from a fraud allegation, so I'd much rather go on the offensive.

I'll accept any and all advice here, but I do have one specific question: If I end up having to sue Plan A and/or Plan B, am I obliged to name my employer as a defendant in the suit as well?

submitted by /u/dwkindig
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If my diabetes caused tooth and other oral/mouth/gum problems, can my medical insurance be used?

Puffy Lux
Better water better life

	 GlacialPure Filter for Frigidaire WF3CB, PureSou

Before I was diagnosed with Diabetes T2, I was having lots of issues orally, with odor, bad breath breath, increased tooth decay and sensitivity, flaking of enamel, and sore/red gums. I had never had these issues prior to the diabetic symptoms.

No matter what I did, nothing cleared it up. I tried all kinds of different mouth washes, toothpastes, brushing more often, etc etc.

Now, if I go to my dentist, I have a low annual maximum and everything else is out of pocket. But, I blame diabetes for my tooth problems, which I am curious if it can be claimed through regular medical insurance rather than dental?

Thank you in advance for any information.

submitted by /u/FatNorm
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Independent Contractors. Where do you get your medical and dental insurance from?

Puffy Lux
Better water better life

Im thinking of switching jobs and becoming a independent contractor. The new gig provides no medical or dental . Where can i request quotes or where do independent contractors get their medical and dental insurance from?

Also. What is the ballpark range for monthly rates?

submitted by /u/MilkSteaknShake
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Ok, so I have a question or 2 about auto insurance regarding medical payments [CA]

Puffy Lux
Better water better life

I got T-boned about a month ago by people that dont have insurance. So far I’ve only accrued $38 of medical bills (co-pay and some pain meds) but I may be accruing more pretty soon, I started having lower back pain about 2 weeks after the accident and I’m not sure how much everything is going to cost, going to my doctor soon to see what can be done.

I have $1,000 coverage for medical payments, 50k per person/100k per accident for bodily injury, and 50k per person/100k per accident uninsured motorist.

My questions are, if the medical bills happen to go above $1k, do I just have to pay out of pocket or would it also draw from my uninsured/bodily injury coverage? Because if it’s only the $1k coverage that would really fucking suck

submitted by /u/That_random_guy-1
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My wife and I are moving back to the states from Germany. We leave August 16th but she needs medical attention and we have no insurance.

Puffy Lux
Better water better life

My wife and I have lived in Germany for two years and have a flight to Idaho on Friday. She has fluid in her kidney and an overractive thyroid.

Puffy Lux

If approved by the doctor here in Germany, we could postpone treatment until we secure insurance in the states. Of course, without inurance this ordeal could bankrupt us pretty quickly. We are "low-income" and probably eligible for Obamacare. I need to know how quickly we can get insurance if we moved to the US. Does anyone have an idea?

The green card entry timeframe ends on September 9th, meaning she has to touch down before this date or else we may have to do the very long, very expensive application for a visa again.

Any insight or info is much appreciated!

submitted by /u/nonoQuadrat
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does medical malpractice insurance company need to be aware of 15 year old unrelated expunged case?

Puffy Lux
Better water better life

A friend in Oregon is just beginning his medical practice. In applying for malpractice insurance, he was asked if he has ever been arrested or convicted of a crime. He was.. 18 years ago for stealing bowling shoes from a bowling alley when he was an undergrad. It was expunged 15 years ago in the state of NH where the incident occurred. He has disclosed this information to licensing boards as he felt he had to for state licensing purposes but is unsure if it's necessary to disclose to malpractice company.

I believe his rate may increase with this information and that it may not be necessary, relevant or legally required, as per the purpose of expungement. Right? He does not want his policy to be nullified should a malpractice case be brought against him in the future, with this possibly resurfacing, if he does not disclose it now. But I thought the point of expungement was that you could say "No" when asked if you've ever been arrested or convicted or whatever.

So what's the deal with expungement? Is he protected from sharing that with anyone ever, or does he need to share it while applying for medical malpractice insurance?

Thanks for helping us settle this!

submitted by /u/stinkfacebutt
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Obtaining records for medical insurance in California

Better water better life
Puffy Lux

I know that in California, there are laws dictating the availability of medical records from physicians. However I have not been able to find anything about getting records from an insurance company.

The first and only treatment that has helped my wife’s chronic back pain is being denied by our insurance provider. It has been appealed up to the highest internal level, where the reviewing doctor in a peer to peer review stated that they would not approve it, although he has performed the procedure frequently and believes my wife is a perfect candidate.

I want to get the records, including notes if possible, of this denial. It will better help me equip myself for a third party review of the care.

submitted by /u/jericon
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Medical Insurance

Puffy Lux
Better water better life

Dumb question but… I have HMO insurance. This means i can only get covered if i use in network providers. I have a primary doctor, but they don’t have a vaccine i need to get. If i go to a different doctor and get the vaccine at their office, and it’s still in my network, I’m still covered right? As long as i use in network?

submitted by /u/abmula
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What are my options for medical coverage in a motorcycle accident in Nee Jersey?

Better water better life
Puffy Lux

I currently have progressive motorcycle insurance with 2.5k in medical payments in case of an accident. I believe it only goes to 5 or 10k. I am 20 and still under my parents health insurance. My dad states that through his company, my medical bill would not be covered if i wrecked my motorcycle. Do i have any options regarding an expensive medical bill if i crashed?

LA Series

submitted by /u/yunglad24
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An immigrant’s experience at a US medical provider

Puffy Lux
Better water better life

I came to the US for work opportunities. I am very grateful to be here and happy to call this place home. I have an excellent employer, and good health insurance benefits.

Roses

During a friendly soccer match I sprained my ankle. It was pain unlike I had experience before in that area, and so I sought out UrgentlyOrtho, recommended to me by my GP. By now I am used to the fact that I have to provide my insurance multiple times, triple validating, andsoforth. But I had not really experienced the brazen up-sell culture yet. As soon as insurance is in place, it's a free for all. They were 'kind' enough to offer me every service and piece of equipment available. I took the crutches and the pneumatic boot, because I was in pain, and needed to be able to get around. They suggested that the insurance would take care of it, and everything would be alright.

What I found out after a month, when I finally got the bill is that they managed to charge thousands of dollars out of that one visit. The most egregious was the pneumatic boot. Somehow they managed to charge my insurance $600 for it (a quick look on amazon gets me one for $40). Naturally my insurance doesn't cover everything, and so I am liable for about 25% of it myself. (How that calculation came about was left out)

How did the system get to this point? How are these medical providers allowed to be so brazen and unscrupulous? Moreover, can I do anything about this?

At times like this, I'm happy that this is my country only temporarily.

submitted by /u/never-knew-me
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