Health Insurance

[FireWeatherMet]

Well let's change that, we all need health care and are all in one group.

Finally, you've said something sensible.

 

[PessOptimist]

I know health insurance has been discussed here and there in other threads. Found this one and thought I’d bump it.

Open season is coming up for FEHP, FEDVIP and FSAFEDS; 9 Nov-14 Dec 20. https://www.opm.gov/retirement-serv...fits-administration-letters/2020/20-401a1.pdf.

I currently have retiree BCBS basic which I am fairly happy with except of course for the premiums. I also have Medicare A and B plus TriCare for Life. SWMBO has BCBS and TriCare Prime. She will soon have the same as me. Yeah I know, am working on suspending BCBS to see how it goes but other beneficiaries are skeptical.

I have been using MetLife Dental FEDVIP for a long time. Not great but OK until 2020. Looking for experiences with other providers listed by OPM for 2021.
Aetna Dental PPO
Delta Dental PPO
BCBS FEP Blue Dental
GEHA Dental PPO
MetLife Dental PPO
United Concordia PPO
UnitedHealthcare Dental PPO*
HealthPartners*
Humana EPO/PPO


This calendar year Metlife FEDVIP has started denying claims, stating my primary insurance covered procedures. Who? I had called a few times but got a recording stating wait times were hours. I sent them a snail mail about one of the claims. Today I called again about another claim and to my surprise got a human on the line within 5 minutes. She said my primary Insurer had paid one and the other one needed an xray. My dentist sent an xray but MetLife said it wasn’t good enough. I asked who the primary insurer was and she said it wasn’t listed and transferred me. I got another human within 60 seconds and he was very helpful. I spent over an hour on the phone while he called others with questions. Never got dumped to my surprise.
First claim issue may have been resolved; time will tell. Metlife person said that starting this year OPM demanded other FEP insurers be billed first. Everyone seemed to agree neither Medicare part A or B, nor FEPblue basic pays for dental exams/cleanings. Both ignore such claims and do not send an EOB denying them. Claim is being resubmitted based on FEPblue statement they would not send an EOB for dental claims as any fool knows dental is a separate coverage.
Second claim was for a crown. Metlife called my dentist while I was on hold and they “found” whole mouth xrays that they are submitting. Again, time will tell. This bill is a biggie so I hope it gets paid.

Anyone else been having dental claims denied this year?

PO

 

[James48843]

Not having any problems YET, but found out my Dentist will no longer be accepting Delta Dental after January 1, 2021.

I also found out this morning that my 24 year old son (who no longer is on my FEDVIP Delta Dental Plan, because he is 24), is on my WIFE’s Delta Dental through her employer- anyway- HE is going to need a crown, a root canal, and four wisdom teeth pulled in the next two months.

Anyway- just be sure to ask your dentist if they plan to discontinue your chosen dental coverage carrier. I will be looking for a replacement for Delta- I’ve done fine with them, but it sounds like that isn’t going to work for me next year.


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[PessOptimist]

Not having any problems YET, but found out my Dentist will no longer be accepting Delta Dental after January 1, 2021.

I also found out this morning that my 24 year old son (who no longer is on my FEDVIP Delta Dental Plan, because he is 24), is on my WIFE’s Delta Dental through her employer- anyway- HE is going to need a crown, a root canal, and four wisdom teeth pulled in the next two months.

Anyway- just be sure to ask your dentist if they plan to discontinue your chosen dental coverage carrier. I will be looking for a replacement for Delta- I’ve done fine with them, but it sounds like that isn’t going to work for me next year.


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I did ask the dentist about the carriers I listed. Thanks for that advice. I had Delta under the Tricare Retiree program until they discontinued it in 2018. At that point I dropped the Tricare program as it wasn’t worth it and alternatives were FEDVIP programs so I couldn’t have two anyway. Paid more in premiums than I got in claims having both Tricare Retiree and FEDVIP. Delta was OK paying what it said it would.

Are you enjoying being retired? Don’t let the wife do so if it means dropping the dental plan.

Humorous (to me) thoughts I would have shared with my own son-I have lots of pliers and vice grips, prying tools and a dermal tool. Let’s save some money! Yes, I am a bad person.

I’ll post if I decide to change from Metlife.

PO

 

[nasa1974]

PO, are you getting a $800 refund on your Medicare Part B with your Federal BCBS basic?

 

[PessOptimist]

PO, are you getting a $800 refund on your Medicare Part B with your Federal BCBS basic?

Yes for 2018 ($600), no for 2019 (wageworks.com says I am not eligible for 2019) and not yet for 2020. I have so much going on as far as insurance claims I have not gotten to why no 2019 refund. Thanks for the reminder.

PO

 

[Bullitt]

Aww man what a mess. And I'm sure when you called you got some dumb message like, "Due to these unforeseen times, call wait times might be a little longer." Like it's any more effort to answer a phone whether offices are shut down or not.

To me, dental just never seemed like a good deal. Had MetLife for some 10 years and unloaded it years ago. Just been using FEP Blue to cover basic dental costs since. I remember paying something like $20-25 a paycheck and had nothing but cleanings. No co-pay, but big deal, a co-pay is only $30, so we were throwing money out the window.

FEP Blue did change their X-ray policy out of nowhere and I got dinged with something like $80 for an x-ray. Turns out, they cut most x-rays down to one every three years and the dentist didn't realize it. (Fine print in a 300 page disaster of a pdf file.) A few weeks ago dental assistant said, "okay, time for your x-ray" and I declined because I'm not sure if it would have been covered.

Never had any catastrophic or major dental so I don't know how it would all work out but I doubt MetLife would have paid for much. We paid for orthodontics out of pocket under FEP Blue and it wouldn't have been covered completely even if we still had MetLife. I think you needed to have coverage for a few years prior before using for orthodontics so that's another thing to keep in mind before jumping around. You might not even be able to use the insurance unless you've been on their books for two or three years.

 

[jonfresno]

I have BCBS basic, and Aetna dental. Love Aetna? Maybe like? It helped out when I needed a crown, my wife needed a couple crowns, deep cleanings, fillings etc. I believe they also cover for out of network dentists but you'll pay more than an in-network provider.

My dentist submit everything to BCBS first, BCBS denies the big stuff, then my dentist submits to Aetna. Not sure if this is a good thing, but my dentist thinks Aetna is good. It's just the sucky thing of comparing percentages of what each will cover, and whether your dentist will charge more for the agreed upon rates between provider and insurance company for the services.

Had it for a while. maybe 10+ years.

James - so I assume you'll be coming out of retirement for a year or so to pay for those dental procedures.. :smile:

 

[James48843]

.

James - so I assume you'll be coming out of retirement for a year or so to pay for those dental procedures.. :smile:

No way. I DO have a few sets of pliers around. Not sure if locking Vice grips are the right tool for wisdom teeth, but I’m willing to give it a shot.


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[nnuut]

I have GEHA, had all of my stinkin' teeth pulled last year. They pay half! $85 a month!!!

 

[PessOptimist]

I have BCBS basic, and Aetna dental. Love Aetna? Maybe like? It helped out when I needed a crown, my wife needed a couple crowns, deep cleanings, fillings etc. I believe they also cover for out of network dentists but you'll pay more than an in-network provider.

My dentist submit everything to BCBS first, BCBS denies the big stuff, then my dentist submits to Aetna. Not sure if this is a good thing, but my dentist thinks Aetna is good. It's just the sucky thing of comparing percentages of what each will cover, and whether your dentist will charge more for the agreed upon rates between provider and insurance company for the services.

Had it for a while. maybe 10+ years.

James - so I assume you'll be coming out of retirement for a year or so to pay for those dental procedures.. :smile:

I should have read your reply on 10/13/20 more carefully. I checked today on BCBS Basic and yes they do pay for two exams and cleaning a year and one xray every three years. I never knew that and afaik my dentist has never submitted a claim to BCBS. BCBS rep states it has covered cleaning and xrays forever. Metlife FEDVIP dental rep says submitting claim to BCBS is a new directive this year from OPM. So I think wtf? Or my goodness. Or something like that.

As my usual procrastination has brought me to 4 hours before the end of open season, SWMBO is asleep and I will not make a change without her approval, looks like MetLife is it for another year. I am still somewhat mystified about why in 2019 and previous years my dentist submitted claims to MetLife and Delta 2018 and previously that all claims were paid with no questions.

I had a crown placed on a tooth my dentist had been suggesting for years as it probably was going to break someday. MetLife paid part and I paid $343. When you are 68 years old and your teeth still work and you don’t have pain, you have to think of the value added for dental procedures. How many enhancements do you put in to something approaching it’s end of life?

Dental insurance will be continued since SWMBO likes to have lots of ortho procedures.

PO

 

[James48843]

Quick update:

Last week I had a tooth flare up. I previously had a cavity on the side of the tooth, in a location my dentist said he could not fill. It finally got infected, and became horrendously painful.

So I had the dentist yank it out. It took all of about two minutes for him to grab it with pliers, give it a few twists, and then it was gone. My screams were pretty loud, but in 30 seconds, the pain was gone, and I was good as new. Except for not having a molar there.

I feel much better now, thank you.


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[nasa1974]

Quick update:

Last week I had a tooth flare up. I previously had a cavity on the side of the tooth, in a location my dentist said he could not fill. It finally got infected, and became horrendously painful.

So I had the dentist yank it out. It took all of about two minutes for him to grab it with pliers, give it a few twists, and then it was gone. My screams were pretty loud, but in 30 seconds, the pain was gone, and I was good as new. Except for not having a molar there.

I feel much better now, thank you.


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WOW!! U da man. Getting that tooth yanked with no pain meds.

 

[nasa1974]

I should have read your reply on 10/13/20 more carefully. I checked today on BCBS Basic and yes they do pay for two exams and cleaning a year and one xray every three years. I never knew that and afaik my dentist has never submitted a claim to BCBS. BCBS rep states it has covered cleaning and xrays forever. Metlife FEDVIP dental rep says submitting claim to BCBS is a new directive this year from OPM. So I think wtf? Or my goodness. Or something like that.

As my usual procrastination has brought me to 4 hours before the end of open season, SWMBO is asleep and I will not make a change without her approval, looks like MetLife is it for another year. I am still somewhat mystified about why in 2019 and previous years my dentist submitted claims to MetLife and Delta 2018 and previously that all claims were paid with no questions.

I had a crown placed on a tooth my dentist had been suggesting for years as it probably was going to break someday. MetLife paid part and I paid $343. When you are 68 years old and your teeth still work and you don’t have pain, you have to think of the value added for dental procedures. How many enhancements do you put in to something approaching it’s end of life?

Dental insurance will be continued since SWMBO likes to have lots of ortho procedures.

PO

At 68 I think all my molars are capped and I've had two teeth pulled and one root canal. At least I can chew a good steak. I have BCBS basic and GEHA dental. Been pretty happy with both. Even with dental insurance, mouth work is expensive.

 

[PessOptimist]

PO, are you getting a $800 refund on your Medicare Part B with your Federal BCBS basic?

Yes for 2018 ($600), no for 2019 (wageworks.com says I am not eligible for 2019) and not yet for 2020. I have so much going on as far as insurance claims I have not gotten to why no 2019 refund. Thanks for the reminder.

PO

I would swear this reimbursement thing was talked about in another thread but no matter.
I never followed up on the 2019 reimbursement. I got it for 2020. Today I got a reminder from HealthEquity, Inc to apply for the 2021 reimbursement. Finding a record of payments was impossible. MyMedicare tells me to go to MySSA. MySSA tells me to go to medicare.

Last year I found a nice record of payment at mymedicare.gov/monthlypremium.aspx. This year the mymedicare site redirects me to medicare.gov which as I stated tells me to go to myss. So I tried submitting a benefit verification letter. We shall see.

Nasa, what did you submit as a proof of payment?

PO

 

[nasa1974]

I would swear this reimbursement thing was talked about in another thread but no matter.
I never followed up on the 2019 reimbursement. I got it for 2020. Today I got a reminder from HealthEquity, Inc to apply for the 2021 reimbursement. Finding a record of payments was impossible. MyMedicare tells me to go to MySSA. MySSA tells me to go to medicare.

Last year I found a nice record of payment at mymedicare.gov/monthlypremium.aspx. This year the mymedicare site redirects me to medicare.gov which as I stated tells me to go to myss. So I tried submitting a benefit verification letter. We shall see.

Nasa, what did you submit as a proof of payment?

PO

PO,

I got my information from the Social Security website. I logged into my account and downloaded my "2021 Social Security Cost of Living Adjustment" page. I made a copy of that information and then went to my BCBS account.

Service Benefit Plans and Medicare Part A/B - Blue Cross and Blue Shield's Federal Employee Program (fepblue.org)

Filled out all the information and submitted it.

 

[PessOptimist]

I received a refund a couple days ago. I submitted for both spouse and myself and both of us got a confirmation email but so far only one deposit. Should both of us get the refund on a self+1 enrollment? Thought someone on here said yes.

PO

 

[nasa1974]

I received a refund a couple days ago. I submitted for both spouse and myself and both of us got a confirmation email but so far only one deposit. Should both of us get the refund on a self+1 enrollment? Thought someone on here said yes.

PO

Yes. When I applied for our refunds I had self+1. I had two separate deposits on the same day. Hope the other deposit shows up soon.

 

[PessOptimist]

FWIW, today a paper check emerged from SO's pile of correspondence. Dated 4/21/22, no idea when it was received. Answer to NASA's long ago question and for anyone else's information. So I got the $800 reimbursement for 2021 from BCBS for Medicare part B for both of us.

PO