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Medicare’s COB Unit (Coordination of Benefits and Recovery Center)

There are many tasks to be addressed in transitioning to Medicare and many different entities are involved, Social Security, Medicare, a private supplemental insurer, a prescription drug plan program, and/or an Advantage Plan AND, least known, Medicare’s Coordination of Benefits and Recovery Center (let’s call it Medicare’s COB Unit).

As I indicate in this week’s video, you might be the conscientious soul who has made all your decisions with respect to Medicare, completed your enrollments, has all your new cards in hand and still face the vexing issue of claims not being processed accordingly.

How can this be? Often it is because the little-known Medicare COB Unit does not have updated information as to whether Medicare should be primary (paying first) or secondary (paying second).

On the first of the month of your transition to Medicare, call Medicare’s COB unit at 855-798-2627 and listen to the automated line to ensure they have the correct information on file. You want this Department to know that Medicare is primary, or pays first, when it should be primary. Otherwise, Medicare will be looking for another insurance company to pay claims first which can turn into a headache for you. Of course, you also have to inform your doctors and other providers when your coverage changes, so they submit claims correctly.

Everyone who is transitioning to Medicare should make this call. We feel those transitioning to Medicare during a Special Enrollment Period, however, should be even more proactive and send a letter to this Department notifying them of the date Medicare should be primary. Best to do this via facsimile, 405-869-3308, even though this seems outdated. Fax this letter about four weeks before Medicare should be primary and, later, check the automated system after two weeks or as recommended above. If the system hasn’t been updated, stay on the phone to reach a representative and provide the necessary information. Those who enroll during a Special Enrollment Period have continued to have active group coverage through their employment or a spouse’s employment beyond age 65 and are the most likely group to experience their coverage information not automatically updated.

If you don’t want to use the automated system, you can always choose to call and wait for a representative to help you.

We always perform this task for our clients. However, during 2022 we had two clients for whom the information was correct when checked and then later, quite inexplicably, reverted back to incorrect information. This didn’t have a significant impact on the first client. But the second client who had surgery shortly after retirement was terribly inconvenienced by this issue. Medicare was supposed to pay as primary but Medicare’s system was still showing his former group coverage as primary. Because of the volume of claims, it was a bit of a mess. In fact, he got back to us to recommend that anyone scheduling surgery shortly after retirement should plan a transition to Medicare farther in advance to avoid this problem.

We were so sorry he had this problem but, in our experience, these two client’s situations were very unusual. Nevertheless, it is important that everyone knows this Department exists and that its role is to make sure Medicare only pays claims when it should. That is good news for the American taxpayer but not good if you are the beneficiary and legitimate claims are not paid.

Please add this task to your list if you are transitioning to Medicare and, as always, watch the video, like us, follow us, and spread the word. Thanks!