Stopped payments two years ago, and insurance company still thinks the

[Guest Bruce Lanndess]

I just encountered a strange conflict with a former insurance company.I retired from work in 1997 for health reasons and continued making monthly patments for the Cobra extension coverage with the same insurance company that I was covered with when I was still working.

After a few months, I qualifyed for SS disability and became eligible for medicare and, as I was instructed, imformed the insurance company I was now on medicare and stopped making payments for the Cobra coverage.

About two years ago I was involved in a serious car accident and was still covered by Cobra. So that information remained in the system.

Recently, I made an appointment with a surgeon I had never met, but another surgeon, who happen to have treated me in the past when I was recovering from the accident, stopped by and asked me a few questions.That was a $150 consult.

Later, I received a bill from my exsurgeon, and they brought up my records from the past and didn't bother to update the info. and sent the bill to my former insurance company. So I called the doctor's office and thought everything was updated. Then I just received a summary of the charges and my exinsurance company and, would you believe, the company processed the claim.

So I called the surgeon's office again and explained I am only on medicare, but the woman insisted that my exinsurance company and medicare are both listed as the primary insurers and I would have to clear that up by calling my former insurance company. Wouldn't you think an insurance company would have received a clear message, that I havn't sent any payments to them for about two years? Why in the world, would I have to clear up a problem, when I don't see any major problem?

Bruce

[Guest Brook]

Having worked at a few health claims operations, I'm sorry to say I am not surprised to hear your old company is paying claims two years after you stopped paying premiums. Sounds like their eligibility files are not well maintained.

Unfortunately I doubt the company would be shy about trying to recoup what they paid incorrectly, even if it is their fault. It might be worth a call to them to bring the error to their attention, to prevent any further overpayments to other providers who may have outdated information.

The woman at the surgeon's office should have enough sense to know that two companies cannot both be primary at the same time. It is clear however that she views this as your problem. I have known doctor's offices to throw up their hands and just dump the mess in the patient's lap to straighten out.

It is clear you are blameless in this situation, but straightening out a bunch of overpayments down the line is still a headache. I recommend the call to your old company.

[Guest Bruce Lanndess]

Brook, disregard a e-mail I just sent. I thought I was responding to the insurance company.

Believe it or not, the story is getting more bizare and is almost funny. Looking for a quick fix, I called the doctor's office and explained the problem. Then I asked her to delete any reference to the wrong insurance company. She told me that wasn't possible.

Then I realized that I had to call the insurance company that I had stopped paying the premiums and, of course, she was eager to solve the problem, but still insisted I was still "elgible."

Even though the mixup appears to be straightened out, it concerns me that company is still in my medical records. I am close to having a major surgery, and the last time I had to deal with this company and State Farm, it was a nightmare. It was about three years ago and all of this was new to me. I didn't know which company was the primary and which company was receiving the bills.

I can't believe the doctor's secretary couldn't edit my records, so it won't happen again.