I have enrolled in Medicare PART-A on JUL 2020 when i turned 65. I continued to work until SEP 2020 and had EGHP (Employer Group Health Plan) until SEP 2020. My job got terminated on SEP 31 2020 but the employer as part of severance agreement to provide COBRA coverage until DEC 31 2020 fully paid by the employer. As of SEP 2020 due to termination of employment I was in SEP - special enrollment period for Medicare Part-B (8 months starting from OCT 1 2020 until May 2021). However I applied for Medicare PART B in Sep 2020 submitting all necessary forma and got approved for Medicare PART-B.
United HealthCare insurance which provided the insurance coverage for the EGHP made me believe they are the Primary Insurance provider and hence I requested Medicare PART-B to start from Jan 1 2021 instead of OCT 1 2020. Subsequently I had a surgery in DEC 2020 and all invoices from Hospital, from Surgeon who performed the surgery and the Anesthesiologist went to United Healthcare who processed the claims as secondary to Medicare instead of Primary (as they told me before the surgery was scheduled). Now I am facing huge hospital bill, a surgeon bill and an anesthesiology bill. In order to reprocess those claims I need to get the PART-B start date reset to DEC 1 2020. PART-B start date was wrongly chosen because of misguidance and assurance by United Health care before surgery that they are Primary Insurance providers. Can you guide me how I can get the PART-B start date changed to DEC 1 2020 so that these invoices can be resubmitted and I will get a financial relief (In 2020 I was told PART-deductible was 1408 and Part-B deductible is 198) As secondary to Medicare United Health might be able to cover these and also the 20% Co-insurance I think. PLEASE GUIDE ME – sorry for this late request since much of the time was spent in appeals and other means of getting resolution
Hi. This is outside of my area of expertise, but it doesn't sound to me like you could qualify to have your Part B Medicare enrollment moved to an earlier month. There is a provision called 'Equitable Relief', but that provision applies to situations where a person's enrollment or non-enrollment in Medicare was prejudiced due to the error, misrepresentation, or action or inaction of an employee or agent of the Government. In your case it sounds like you were misled by someone from your EGHP insurance company, not a government agent.
The equitable relief provision is explained in the following sections of Social Security's operations manual: https://secure.ssa.gov/apps10/poms.nsf/lnx/0600830001 & https://secure.ssa.gov/apps10/poms.nsf/lnx/0600830005. If you believe that you meet the requirements for equitable relief you'll need to submit a request for such relief to Social Security.
Again, though, please understand that my expertise is limited to Social Security benefits. You should probably try to discuss your problem with a Medicare expert.
Best, Jerry