Advocacy in Action | Benefit Education
A member contacted The Purple Card for assistance. He had primary coverage through his employer’s BCBS plan and secondary coverage with Medicare Part A only, no Part B (Part A covers inpatient hospital care and Part B covers items such as outpatient services, laboratory tests, x-rays, etc.) Here is his story.
We moved here from Canada about twelve years ago, and it has been a challenge to understand how the different moving parts of my insurance plan work: my employer‘s BCBS insurance, vs. Medicare. I obtained Medicare Part A (free) a year and a half ago when I registered with Social Security, and I knew nothing about the differences in Medicare Part A vs. Part B. I was comparing this current claim experience to two previous ones: (1) an Emergency Room visit where I paid the $200 copayment, with no further costs and (2) my hospital stay for 4 days just over a year ago where virtually everything was covered between BCBS and Medicare. So I naively thought it would work the very same way this time. I also thought BCBS would pick up everything beyond the $200 Emergency Room copayment. The lights came on when I learned more about my employer’s BCBS plan and Part A vs. Part B benefits. I learned my BCBS employer plan pays 80% of the Allowable Amount after $200 Copayment Amount with 20% being my responsibility. Because I was not admitted to the hospital, my Medicare Part A benefits for inpatient hospital care did not apply. Now I understand!
Thank you for your patience in explaining and providing the claims documents for me to review. Really appreciate you and the attachments and explanations you sent to help me to finally understand everything.
At Brinson Benefits, we care about the patient’s best interest. We believe the patient should have an available healthcare navigator and advocate. Our Patient Advocates at The Purple Card® are highly trained to educate members about available benefit programs. They work hard to resolve issues with providers and insurers.
The Purple Card® is an independent health care advocacy and assistance service. Our Patient Advocates provide time and cost-saving services to resolve concerns about benefit programs. We not only assist our members, we educate them on ways to maximize health care coverage and other available benefit programs.
