• Medicare

    Medical Services Abroad

    Medicare does not pay for medical services outside of the United States except in these few rare circumstances: You’re traveling between Alaska and another state and have a medical emergency that requires you to be treated in Canada. A medical emergency occurs while you’re in the United States or its territories, but the nearest hospital is in a foreign country. For example, across the border in Canada or Mexico. You live within the United States or its territories and need hospital care, whether it’s an emergency or not, however your nearest hospital is in a foreign country. The three most popular Medicare Supplement (Medigap) policies I sell, plans F, G,…

  • Medicare

    Annual Medicare Wellness Visit

    First let’s make clear what a Wellness Visit is not. It’s not a physical exam, so be clear when scheduling this appointment with your doctor. The Medicare Wellness Visit, also called a wellness exam, is when you and your doctor put your undivided attention on your health. You’re not there because you’re sick or in pain or needing a prescription. And your doctor is not there to diagnose or treat a health problem. The primary purpose of the Medicare Wellness Visit is prevention. It plays a key part in helping to reduce your risk for common preventable health problems such as heart disease, stroke and type 2 diabetes, as well…

  • Medicare

    Which Agency to Call

    For historical reasons, the administration of Medicare is split between two federal agencies: the Social Security Administration (SSA) and the Centers for Medicare & Medicaid Services (CMS). Social Security Administration 800-772-1213 or ssa.gov Eligibility for Medicare Medicare enrollment and disenrollment Paying higher-income premiums and requesting waivers Paying Part B late penalties Obtaining a replacement Medicare card Reporting change of address or a death All questions regarding Social Security retirement and survivor benefits, disability benefits (SSDI), and Supplemental Security Income (SSI) Centers for Medicare & Medicaid Services 800-633-4227 or medicare.gov Medicare coverage for medical services and supplies Billing and payment questions Finding doctors who accept Medicare patients in your area Finding…

  • 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…