Entitlement to Medicare Question

[Guest Gibson]

We have a situation where we failed to cut off COBRA when the qualified beneficiary became entitled to Medicare. Person went on COBRA in 8/99. He became social security disabled in 7/99, notfied us within 60 days of 8/99 (that's another issue - should we have extended COBRA to 29 months even though he became social security disabled prior to having COBRA? Can we fix this?) and we extended COBRA to 29 months. In 1/2000, he became entitled to Medicare, and notified us, but we failed to cut him off. In 8/2000, our stop loss insurer notifies us that we should have cut this guy off effective 1/1/2000, due to his entitlement to Medicare, and that they are not going to pay his $170,000 in claims incurred in 2000. What can we do in this situation? Thanks.

[Linda]

I'm guessing some of the claims that should have been paid by Medicare were inadvertantly paid first by the group health plan. If the dual coverage had been proper, Medicare would have been primary (unless the individual had ESRD). Could you try to get this re-processed with Medicare?