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Mrs. Smith had been getting a bill for surgery (over $700) and had been unsuccessful in getting it sorted out. For over a year she had been getting the run-around and there was no way she could afford such a bill, so it was becoming a reality that she was going to be sent to collections. Confused, frustrated and utterly discouraged Mrs. Smith had nearly given up that this would ever be resolved. In a final attempt at resolution she called to see if Inland Agency HICAP could help in any way.
Inland Agency HICAP Volunteer Counselor, Vince Marino met with Mrs. Smith and worked through the mound of correspondence she had. It seemed like the problem started when she wanted to change her insurance plan during Annual Enrollment. Because she doesn’t drive, Mrs. Smith needed help with transportation, and unfortunately the plan she was initially interested in advised her that they did not have a transportation benefit. Consequently, she told the new plan to cancel her enrollment paperwork, which they did, and in fact, Mrs. Smith received confirmation from Medicare that she was still in her old plan.
However, her current insurance plan found out she had enrolled into a new plan, so they cancelled her coverage, without her knowledge. Believing she was still with the same plan, she proceeded to have her surgery. After her insurance paid the bill, they realized she was cancelled and demanded reimbursement from her providers for the surgery. Once the provider reimbursed the insurance plan, they billed Mrs. Smith. She is low income and cannot afford to pay the bill, and tirelessly tried to get the insurance company to explain to her why she was dis-enrolled to begin with. The only answer Mrs. Smith was given was that Medicare enrolled her into a different insurance plan so she would need to talk to them. Inland Agency HICAP was able to find out exactly why her insurance cancelled her, and because it was through no fault of her own, in working with Medicare, was able to get her retroactively re-enrolled with her plan without a lapse of coverage and her plan has now paid the over $700 bill.