Over the winter, however, I wrenched my back shoveling snow. I needed physical therapy for my back. Now the claims for my back are being denied; Medicare states my auto insurance needs to pay this claim.
My auto insurance will not pay since my back injury was not related to the car accident of 2001. This is so frustrating. What can be done?
As you state, you have two separate injuries: Your neck was injured in a car accident back in 2001, and your back was injured while shoveling snow last winter.
With the first accident (neck), your personal injury protection under your auto insurance paid the medical claims and Medicare denied payment. This was the correct payment arrangement: Medicare paid secondary to your auto insurance, and since your auto insurance paid the full amount, Medicare did not make any payments.
Your second injury was to your back and was not related to the auto accident. You will need to make a phone call to rectify this situation. Contact Medicare Coordination of Benefits (COB) to determine if your Medicare record has been corrected to show that Medicare is now the primary payer. The number to Medicare's COB is 800-999-1118.
The COB office will advise you of what needs to be done to "clean up" your record to show Medicare as your primary insurance. COB may advise you to have your provider resubmit the claims so they can be reprocessed. Your provider will want to make a notation on the claims that the back injury is not related to the auto accident.
If your claims continue to be denied, you may appeal your case to Medicare following the instructions provided on your Medicare Summary Notice. You are advised to have your provider provide medical documentation and/or a letter that shows the back injury was not related to the auto accident.
Please be advised that there is a time limit on filing an appeal. This time limit is provided on your Medicare Summary Notice.
I have the Maryland Senior Prescription Drug Assistance Program (SPDAP), which pays $25 toward my Part D drug plan premium. Since the state pays my full premium amount, why is the premium still being deducted from my Social Security check?
SPDAP will pay up to $25 toward a Medicare drug plan premium cost for people with an income below $32,490 per year (below $43,710 a year for a married couple). However, for SPDAP to work correctly, you cannot elect a Social Security deduction for your Part D drug plan.
While it seems logical that you should contact Social Security to correct this situation; Social Security will not make the correction. Instead, contact your Part D drug plan and request they no longer have a Social Security deduction on record. Also request that your Part D drug plan review your account and refund you the money due for the premiums that were overpaid.
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Amy Rubino is the director of the Senior Health Insurance Assistance Program for the Anne Arundel County Department of Aging and Disabilities. You can reach SHIP at 410-222-4464 or ship_program@aacounty.org.
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