Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION: I feel like every time I answer the phone there is someone calling me about Medicare Insurance. Why do I receive so many calls?

 

ANSWER: This is such a great question and I hear it so often. Medicare, also known as Centers for Medicare and Medicaid Services (CMS) rarely, if ever, calls anyone on Medicare insurance.

This clarification is important for two crucial reasons:

  1. Every time you answer one of those calls you risk being switched to an insurance product you may not want and you may not understand.
  2. Sometimes those calls could be coming from someone committing Medicare fraud.

In both situations, the caller is trying to get YOU to say “Yes” at some point in the conversation, and obtain your Medicare ID number.

Not too long ago, your Medicare ID number was your Social Security number. In 2018, CMS began mailing everyone with Medicare insurance an ID card with a ID number unique to you, which is a combination of letters and numbers. This unique ID number helps to prevent some of the identity theft we were seeing.

People who want to commit fraud still want to get that ID number from you. All of your providers need that ID number to bill Medicare for your appointments and treatments. Those hoping to defraud Medicare also need that ID number from you.

Other individuals who aren’t looking to defraud Medicare, but alternatively enroll you into different insurance, also need that Medicare ID number. If/when you decide to change your insurance during the annual open enrollment period each year (October 15 to December 7) you will need your Medicare ID number to make that change.

There may be other opportunities to change your Medicare insurance during the rest of the year, and we call these Special Enrollment Periods (SEP’s). That is why those brokers want your Medicare ID number almost all year long. Many insurance brokers get a commission or get paid for enrolling individuals into the insurance products they are affiliated with.

Most of these types of calls you receive are not local people, they are calling from other parts of the country or other countries with the sole goal of getting that Medicare ID so they can use it as they choose for fraud or to switch you insurance from the product you currently have to something that pays them a commission for making the switch. If you receive a call from someone you don’t know or who you have not talked with previously, you shouldn’t answer that call.

Your primary way of protecting yourself is: DON’T answer the phone from unknown numbers. Let it go to voicemail and then only call when you know it’s a legitimate call.

If you do answer the phone from an unknown number, remember, they want you to say “Yes.” When you say “Yes” in response to ANYTHING, they can fraudulently use this word to enroll you into different products, or purchase something you don’t need or want. So, when they say “Hello, is this John Doe?” DON’T answer “Yes” – instead ask “Who is calling?”

Another way to protect yourself is to review your mail and your explanation of benefits (EOB) from your insurance company for treatments, doctor visits, and medications. Look them over to see if they are all valid dates and procedures. Be thorough in reviewing your EOB, including insurance carriers and the pharmacy, the items billed, and medications filled at the pharmacy or mail order. Sometimes those EOB’s are not for anything you had done, and that is fraud.

If you are concerned about a procedure, product or medication, I encourage individuals to call the provider first to clarify the bill. If you don’t receive satisfying information, feel free to contact Medicare (1-800-MEDICARE).

If you get a new insurance card in the mail and don’t know why, you could call the company to see what is happening. You also could call Medicare to ask when and why your insurance was changed (1-800-MEDICARE).

The number they use for both Medicare and Medicaid fraud is (877-678-4697). If we are diligent in our efforts to protect against fraud, our Medicare dollars will be put to more productive use, covering your medical costs.

CMS is working hard to keep Medicare a reliable, successful, and financially solvent insurance product available to those Americans who have Medicare coverage. Your diligence in reviewing your Medicare Explanation of Benefits and protecting your Medicare ID number will help them with this job.

Read all Inside Medicare articles HERE.

 

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, fill out the contact form below or call 716.849.1540.