True Story: 1

Today we wanted to share our first true story of an experience we had with one of our Medicare clients recently. Short disclaimer, all names and sensitive client information will remain anonymous to protect client’s identity.

This client signed up on a Medicare Supplement (Medigap) plan F when they were first eligible for Medicare. Before we jump into this story, it’s important to understand how a Medigap Plan F works.

What is a Medicare Supplement plan? It is a type of health insurance plan sold by private insurance companies to cover the gaps in traditional Medicare. Thus where it gets the term, “Medigap”. When someone chooses a Medigap, original Medicare remains primary and their Medigap plan is secondary. The Medigap plan helps to pay for costs that would normally be the client’s responsibility under traditional Medicare such as copays, coinsurance, and deductibles. With Medigap plans, Medicare pays first then the Medigap plan steps in and pays its share. Depending on the Medigap plan selected, this could mean the remainder of a bill.

In this post, we are talking only about Medigap Plan F. Take a look at the chart below that shows the Medigap Plan F benefits:

Medigap Plan F

As you can see, Medigap Plan F pays for all the gaps in traditional Medicare Part A and B (Part A deductible and Part B outpatient deductible, Part B 20% that Medicare does not cover, excess charges, etc) Typically, this means anyone on a Plan F should not receive any bills for out-of-pocket costs from their providers.

Now, let’s get back to the story of our client. This particular client went to their provider and had to have lab services done. Lab services fall under Medicare Part B. The client showed the provider their Medicare ID card as well as their Medigap Plan F insurance ID card but still received a bill from their provider for $250. The client, worried their bill would go to collections, paid their provider the $250.

The client then remembered our previous conversations we had about their Medigap Plan F and called me to tell me of their scenario. I explained the bill was likely sent to them in error and possibly never made it to their Medigap Plan F insurance company. We called their insurance company and not only did they receive the claim, they had already paid it and showed the check was cleared. So, the client’s provider was double paid for the same service!

At this point, the client was understandably upset that no one from the provider’s office caught the error and reimbursed them for the services they were not responsible for. I made it my goal to ensure the client received all of their money back from the provider. We called the billing department for the lab every week for 2 months reminding them the client was owed their reimbursement. During this 2 month period, the lab took new ownership and had a total turn over on employees. It appeared that each time we called, we spoke to a brand new billing representative and had to state our case all over again. Though we were frustrated, we did not give up!

Eventually, the client was feeling defeated and called me to say that they had given up on the idea that they would be reimbursed their $250 and that maybe we should just forget about the whole situation. I, however, did not want to throw in the towel. It was important to me that they receive their reimbursement for a service they were not responsible for in the first place.

After about 3 months, the client FINALLY received their check in the mail from their provider for $250. The client called me elated and grateful that I, their insurance agent, took the time to help them and would not give up until they received the $250 that they were owed.

This story is a good example of a simple billing error that can cause issues and frustrations. The client was not responsible for the bill but was nervous of it going to collections and paid it any way. Typically, I advise my clients who have a Medigap plan to give me a call if they ever get a bill for services they receive before they pay it. This way we can review it together and possibly help avoid paying for something that may not actually be their responsibility. It is always a good idea to clarify!

We hope this post was helpful to anyone who may face similar situations. If you have any questions or concerns, please feel free to reach out.

I know it’s only Thursday, but have a great weekend everyone!



Who We Are & Why We Are Here

This is our second attempt at blogging here at IIS. We set up a blog last year but weren’t able to give it the TLC it needed to take off and therefore it ended up sitting there with maybe three posts. This time, we hope to be able to keep it updated with information people actually care about and find intriguing.

So, why is an insurance agency based in Grapevine, TX taking time to write a blog anyway? Well, in short, because it seems necessary. The health insurance market is constantly changing and for some agencies, it can be sink or swim. We’ve realized that many of our clients are actively reading social media and keeping up with blogs. We wanted a place where we can stay in touch with people but in a more personal and informal setting.

Just like all occupations, we have stories and experiences we think can help consumers. This blog is our outlet for sharing our thoughts, ideas, and experiences regarding all of the things we run into in this industry.

I won’t bore you with the long details about who we are specifically; I’m quite sure you can find that on any “about us” section on our website or social media pages. I will, however, tell you about the agency in general and what type of business we deal with specifically.

Our agency, Innovative Insurance Solutions, was started over 25 years ago by owner and President of the company, Debbie Gilbert. We are insurance brokers which means we represent and work with multiple insurance companies so we can provide unbiased options to clients. We are based in Grapevine, TX and truly love this community. We do our best to stay active here and to help Grapevine grow and succeed.

Debbie comes from a deep background in the Employee Benefits (group insurance) market. She helps companies find plans like: health, dental/vision, disability, life, etc for employers to offer to their employees. She meets with each person at the company to help explain how the plan benefits work and takes clients through a step by step process from start to finish. Debbie also started an Individual/Family plan department at IIS. This market is for individuals and/or families who are not offered (or do not wish to participate in) group coverage. They can sign up on health, dental, vision, supplemental, and/or telehealth plans that we offer.

Two years ago, Debbie decided she wanted to start a Medicare department at IIS. That’s when she took in Kerstin Key to start-up the department. Kerstin comes from an extensive background in Medicare.

Medicare is a federal health insurance program for people who are 65 or older, certain people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

Kerstin takes time to meet with clients a few months before their Medicare eligible date to help explain the process of Medicare and how to apply for it (if applicable). Then, once a client has their Medicare Part A and Medicare Part B, Kerstin will assist the client in looking for a health plan that meets their specific needs and walks them through every step. She also follows up to ensure the plan is approved and stays in touch with clients to make sure they are taken care of.

We are a full service insurance agency. We will help clients with things like: billing & claims issues, finding new doctors that are in-network, ordering new ID cards, signing up on a new plan, calling the insurance company, etc. We’ve had many clients tell us of their past experiences with agents who signed them up on a new plan and then the client never heard from them again. That is all too common in this industry and unfortunate. We will never be that agent; our goal is be someone’s trusted agent for life.

We really look forward to keeping this blog up and hope that whatever we share can help consumers or other agents who may be facing similar situations.

Thanks for reading!

Be sure to check out our website to see who we are! Click Here