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v.1.2 May 10, 2023 02:30 GMT+7
PT: Raymond W. Hasse: DOB August 7, 1924
Bumrungrad HN 800-301226
FepBlue Member ID: R50608562
May 9, 2023
Bumrungrad insurance/finance department informed Andrew Hasse, Ray’s son and POA, that GMMI said they were not honoring a GOB from November 2022 because Carefirst thought some other insurance company was primary. This rejection of coverage gave the Bumrungrad insurance/finance department concern because Raymond is scheduled to be discharge from the hospital after several weeks of treatment for severe pneumonia, and thus there is a significant bill to be paid.
Apparently, Carefirst, who processes claims for FepBlue which are administered by GMMI, thought that Raymond had a primary coverage (Anthem) in November 2022 when he did not. Note that CMS and United Healthcare can confirm that Raymond had United Healthcare Medicare Advantage from August 1, 2022 to December 31, 2022, and that Raymond did not have Anthem insurance in November of 2022. Also Anthem can confirm that their insurance was not effective from August 1, 2022 onwards. Therefore, during the billing period (November 2022), FepBlue (which is processed by Carefirst, and administered by GMMI), would be primary at 100%.
Excerpt of email from GMMI:
GMMI, as the representative of Ray’s Federal Blue Cross insurance, knows that Ray has Medicare A + B, as well as Medicare PPO plan from prior billings (e.g. November 2021). Thus when Ray is out of the U.S. his coverage is through FepBlue (processed by GMMI). Neither Ray’s Medicare A + B or Medicare PPO (Medicare C + D and other coverage) is applicable when out of the U.S.
Ray was discharged from the ICU at Bumrungrad on April 11, prior to that discharge from the ICU, Bumrungrad contacted GMMI to ask about a private room coverage for Ray given his cognitive disability. GMMI confirmed that a private room would be covered. However, recently, May 9, GMMI sent an updated GOB that listed a “semi-private” room as being covered.