• Medicare

    Medicare’s Two-Midnight Rule

    Medicare’s two-midnight rule could cost you thousands. When you’re a senior with a health issues, going to the hospital is not optional. As we age the chance of hospital visits will increase, as 15% of seniors will have at least one hospital stay and 5% will have two or more hospital stays in an average year.  Unfortunately, some many seniors paid thousands of dollars more than others and received fewer covered benefits — because of a little-known rule called the two-midnight rule. Many seniors don’t even know this rule exists, much less realize how it can affect them, until they end up with a large bill for healthcare services. What is the Two-Midnight rule?…

  • Group Benefits

    Provider Financial Responsibility Went into Effect Jan. 1, 2019

    For all BCBSTX Group Health members the Provider Financial Responsibility for Pre-service Review (PFR) took effect for on Jan. 1, 2019. Details to keep in mind:   PFR does not apply to BlueCard® PPO/International, Medicaid, Medicare Carveout, Medicare Supplemental/Complimentary, Medicare Advantage, FEP and HMO.   PFR is specific to inpatient facility services. It does not include outpatient, professional or pharmacy services billed as professional claims.   PFR does apply to participating facility providers that submit claims for inpatient services – including, but not limited to: acute care facilities, skilled nursing facilities and hospice services performed in inpatient facility settings.   Under PFR, participating facilities are responsible for obtaining preauthorizations required for inpatient facility services.   If preauthorization…

  • Medicare

    Over-the-Counter Hearing Aids

    The Over-the-Counter Hearing Aid Act of 2017 will soon allow people to purchase hearing aids without an audiologist or hearing aid dispenser acting as a go-between. For years, consumers with mild to moderate hearing loss have had few options. At one end of the spectrum are expensive prescription hearing aids that start at over one thousand dollars each. At the other end there are devices called personal sound amplification products (PSAPs) that are not intended to be used for hearing loss and are not allowed to be marketed for hearing loss. Instead, they are usually marketed for “hearing enhancement. Until last year, hearing aids had been regulated as Class I or…

  • Medicare

    Medicare Scam Alert

    It’s been reported some folks are again receiving phone calls from someone saying they are with Medicare and want to send out a new card, but need information. Know this is a scam. According to the Federal Trade Commission (FTC), Consumer Information department, scammers pay attention to the news and know Medicare is sending new cards to everyone who gets Medicare benefits. The cards replace your Social Security number with new number. The scammers may ask you to verify your information or claim there’s a fee for the new card, which there is not. Scammers tell the Medicare recipient they want to send out a new plastic card, but need…

  • Medicare

    Medicare as a Secondary Payer

    Typically Medicare as a secondary payer comes into play when an individual 65 or older remains working full-time with an employer that has 20 or more total full-time employees. If you are enrolled in Medicare, then Medicare coordinates benefits with other insurance that you may have. The primary payer (the one who pays first) pays its portion of covered medical expenses first, in this case, the employer group coverage. Then the secondary payer, Medicare, pays its share of what the primary payer didn’t pay. Sometimes there might be a third payer as well and you may have to pay the balance of what the insurers, including Medicare, didn’t pay. Now,…

  • Uncategorized

    Second Thoughts On Your New Medicare Advantage Plan?

    Did you or someone you know enroll in a new Medicare Advantage Plan or renew one during the Annual Enrollment Period (AEP)? Are you now having second thoughts regarding the coverage? It’s not too late to make a change. Following the Annual Enrollment Period (AEP) and beginning January 1, 2019 a new enrollment period called the Medicare Advantage Open Enrollment Period that will run from January 1st to March 31st and will allow Medicare Advantage Plan members to disenroll from their current MA plan and switch to a different Medicare Advantage plan one time only within this period.  They will also be able to return to original Medicare and purchase a…