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June 27, 2012

ASK SHIP: June 27, 2012

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TERRE HAUTE — Q: I was recently talking to a friend about Medicare. I had a question she didn’t know the answer to, so she referred me to SHIP. What is SHIP?

A: The State Health Insurance Assistance Program provides free unbiased health insurance counseling for people with Medicare and pre-retirees. This year marks the 20th Anniversary of SHIP.

SHIP is staffed by a crew of volunteer counselors who have completed an intensive five-day training course and are certified by the Indiana Department of Insurance. Regular training updates keep our counselors current with the most recent changes in Medicare and other health insurance options. SHIP is a part of a federal network of State Health Insurance Assistance Programs located in every state. SHIP is sponsored by the Centers of Medicare and Medicaid Services (the federal agency that administers Medicare) and IDOI.

SHIP is not affiliated with any insurance company or agency and does not sell insurance. SHIP counselors are committed to offering you free and objective assistance in complete confidence.

SHIP helps answer your questions about Medicare, Medicare supplement insurance, Medicare Advantage, long-term care insurance, prescription coverage and low-income assistance. SHIP provides tools and information to help you make decisions regarding your health care. We strive to help you be wise consumers and to get the most value for your health insurance dollars.

What else does SHIP do?

• SHIP provides you with educational materials and brochures.

• SHIP educates you on how Medicare claims are filed and how you can appeal Medicare decisions.

• SHIP teaches you to assess your needs so you can make informed decisions about your health insurance policies.

• SHIP informs you of your rights as a Medicare beneficiary or health insurance policyholder.

• SHIP shows you how to evaluate the various prescriptions, Medicare supplement, and long-term care insurances that are available.

• SHIP refers you to appropriate agencies that can help you with other needs.

• SHIP provides speakers and presenters for groups, clubs, senior centers and more.

SHIP may be contacted for help with any of these topics via email at www.medicare.in.gov or at 1-800-452-4800.



Q: Medicare didn’t pay for my last medical treatment. It has paid for this same treatment before, so I think there may be a mistake. What should I do?

A: You should be able to file an appeal if you feel there was an error made in your billing to Medicare.

You may file an appeal when:

• A health care service, supply or prescription that you think you should get was denied.

• A payment for health care services or supplies or a prescription drug you already got was denied.

• A change to the amount you must pay for a prescription drug was denied.

• A plan stops providing or paying for all or part of an item or service you think you still need.

How you file an appeal depends on the kind of Medicare coverage you have.

If you have Original Medicare and want to file an appeal, get the Medicare Summary Notice that shows the item or service that was denied. You must file the appeal within 120 days of receiving the MSN.

To file your appeal, follow the instructions on the back of the MSN, or fill out the Redetermination Request Form. With Medicare Advantage Plan your plan sends you materials each year that should explain how to file a complaint, grievance or appeal. Follow the instructions specific to your plan.

With a Medicare Prescription Drug Plan, you have the right to:

• Get a written explanation of the coverage made by your plan called a “coverage determination.”

• Ask for an exception to a drug if you or your prescribing doctor believe you need a drug that isn’t on your plan’s formulary.

• Ask for an exception to a coverage rule.

• Ask for an exception if you think you should pay less for a higher tier drug because your doctor believes it is the best option for you.

To do any of these things, you or your doctor must contact your plan by phone or in writing.

If you feel coverage of your services with a hospital, skilled nursing facility, home health agency, comprehensive outpatient rehab facility, or hospice are pending too soon, you may ask for an expedited appeal to speed up the appeals process. You should call 1-800-Medicare.

If you need help filing an appeal, SHIP can help. Contact SHIP with this or any other Medicare related questions at 1-800-452-4800.

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