Our Blogs:

How You Can Prevent Medicare Fraud  -  December 12, 2012.



Choosing the Right Agent Can Result in Significant Savings on a Medicare Supplement Plan  - September 19, 2012



Medicare Open Enrollment is Approaching - September 11, 2012



Where’s My Health Insurance Premium Rebate? August 29, 2012

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How You Can Help Prevent Medicare Fraud

Margy Wenham December 12, 2012



Medicare fraud is a general term that refers to an individual or corporation that seeks to collect health care reimbursement under false pretenses. This can occur when Medicare is billed for services or supplies you never got.   Medicare fraud is different than abuse: Medicare abuse happens when doctors or suppliers don't follow good medical practices, which leads to unnecessary costs to Medicare, improper payment, or services that aren't medically necessary. A complaint about the quality of care you got from a doctor, hospital, or other provider or facility isn't considered fraud or abuse.



The Centers for Medicare and Medicaid Services estimates that Medicare fraud costs taxpayers tens of billions of dollars every year. 



Officials reported on October 2, 1012 that ninety-one people including doctors, nurses and other medical professionals were charged criminally after an investigation of Medicare fraud that involved $430 million in false billing in seven cities.  The accusations include billing the government for unnecessary ambulance rides in California, writing prescriptions patients in Dallas who did not qualify for them and paying kickbacks like food and cigarettes to patients in Houston if they attended programs for which a hospital could bill. It was the government’s second big raid in recent months after a similar investigation in May involving $452 million in alleged Medicare fraud.



Another case highlights of victimization of Medicare recipients in certain schemes to defraud Medicare.  Jerry Gilman, a 68 -year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling.  His daughter, Deborah, and his doctor arranged for him to have a Hoveround motorized chair to help him with his mobility.  The chair that arrived, however, was not the chair that Mr. Gilman ordered.  It was smaller, flimsier, and made by an entirely different manufacturer.  The daughter  called Medicare and Hoveround.  Both stated they couldn’t do anything as Medicare had already processed the payment for the chair.  After a Medicare antifraud program became in involved it was learned that someone had intercepted Mr. Gilman’s order at his doctor’s office and replaced it with the less sturdy chair.  Eventually, Medicare was able to correct the problem and get Mr. Gilman the correct chair.



Medicare recipient Chuck Johnson of Montana received a telemarketing call offering him diabetic testing supplies that he didn’t want or need.  Even though he was exceedingly clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway.  Mr. Johnson got in touch with a Medicare antifraud and senior advocacy program for help to see if they could help fix the problem.  Not only did his call mean that Medicare recovered money, it also opened up a broader investigation into the national organization soliciting Mr. Johnson.



How should Medicare recipients detect fraud?  First, always review your Medicare Summary Notice or Part D EOB.  Look for charges for something you didn’t get, that you were billed twice for or they reflect services that were not ordered by you or your doctor.



What do you do if you feel scammed?  If you have detected suspicious or erroneous activity on your Medicare Summary Notice or Part D Explanation of Benefits (EOB), you should contact your provider or plan.  If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, there are agencies designed to combat this kind of fraud.   In Northern California the Health Insurance Counseling & Advocacy Program (HICAP) is valuable cost-free asset to available to seniors.  HICAP provides one-on-one counseling service for Medicare related issues - including when there is evidence of Medicare fraud. 



In short, awareness of exactly what your physician has prescribed and paying attention to your Medicare Summaries and EOBs for inconsistencies may prevent future Medicare Fraud.

Choosing the Right Agent Can Result in Significant Savings on a Medicare Supplement Plan

Margy Wenham September 19, 2012



First, what is Medicare Supplemental Insurance?  Medicare Supplement Insurance, in some states called MediGap, is a secondary form of insurance designed to fill the coverage gaps in Medicare parts A and B.  


Medicare Supplement plans are issued through private insurance companies, such as Anthem Blue Cross, Blue Shield and UnitedHealhcare.  By far the most popular is Plan F: most consider Plan F to be hassle free as it pays all of Medicare’s deductibles and there are no out of pocket expenses.



Because Medicare Supplement plans are regulated by state and Federal laws, all benefits for all options are the same regardless of insurer. The primary difference will be the cost or policy rate the insurers will charge for a particular plan. 



Choosing the right agent can result in significant savings on a Medicare Supplement plan.  An agent that represents multiple insurers has the best chance of finding the lowest rates on a Medicare Supplement plan.  In fact, the premiums on a Medicare Supplement can vary by as much as 40% on the same plan between insurance companies.  Consequently, if you are looking for a Supplement plan and go to an agent that only represents a few insurers, there’s a good chance that the lowest rate may be offered by an insurance company that the agent doesn’t represent. 

Bottom-line, the best way to ensure they are getting the lowest premium is to seek out an agent that represents multiple insurance companies offering Medicare Supplemental plans.

Medicare Open Enrollment is Approaching

Margy Wenham September 11, 2012

The Medicare Open Enrollment period is approaching. This year's Open Enrollment Period is October 15 – December 7.



For most people, this is the only time of year to enroll in or switch your Medicare coverage. At Margy Wenham Insurance Services, we care about your individual needs and are here to help you navigate Medicare. We want to provide you with the most up-to-date information and resources to help you find the plan that's right for you. If you're turning 65, losing employer coverage, retiring or disabled, you may be eligible to enroll now. 

If you have any questions, contact Margy at 530-221-0955 or visit our website at www.MedicareSupplementsByMargy.com.

Where’s My Health Insurance Premium Rebate?

Margy Wenham August 29, 2012

In August some people received a rebate check from their health insurance carrier, but many more did not.  To some this has led to considerable consternation to many – especially in light of the Department of Health and Human Services’ (HHS’s) public claim that Americans receiving the rebate will benefit from an average rebate of $151 per household.  The explanation as to why some but not others will receive a rebate is found in the details of the Affordable Care Act.

 Under the federal Affordable Care Act health insurers issuing individual and small group plans must spend 80% of the premiums paid by consumers on health care and activities to improve health care quality.  The percentage of premium income an insurer spends on care and improving quality is called “Medical Loss Ratio” or MLR.  The health insurers MLR is determined separately for each state’s individual, small group and large group markets.  The only health insurers that are required to pay a rebate are those who do not meet the 80% target.



So let’s suppose you were an insured under California Anthem Blue Cross individual plan in 2012.   Based on the report submitted by Blue Cross to HHS they paid 80.9% of your premium on care or improving the quality of healthcare.  Consequently, you would not receive a rebate.  But don’t feel too bad: many California insured persons did not.



About the Author:  Margy Wenham has been working as an independent insurance agent for over twenty (20) years in Redding, California.  She represents most major insurance carriers and can be contact at 530.221.0955 or through her website www.MedicareSupplementsByMargy.com.





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