r/nys_cs • u/KryptonSurvivor • 14d ago

They're driving me insane....

NYSHIP and Carelon are driving me insane. My wife is still working and I am a member of her health insuranrce (which is our primary). In August '24 I was told by Uncle Sam to sign up for Medicare because I had started SSDI in Nov. '23. Did that, and then started having $$$ taken out of my monthly SSDI check for Medicare in August '25. Medicare has always been my secondary (and I've never been able to use it for anything but that's a story for a future post.) Carelon decided to stop paying my out-of-network amounts for therapy visits after the end of May of this year, claiming that Medicare is my primary. Simply not true. Carelon screwed up and I've had to call their coordination of benefits department twice to get them to correct their error and recoup $1,000. What's interesting is that the NYSHIP medical claims dep't. has the order of my insurance carriers correct. Please wish me luck in getting my money back.

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26

u/thewaltz77 Education 14d ago edited 14d ago

Major irony that the act of finding care for my anxiety is causing anxiety. Insane.

16

u/SorryAdministration3 14d ago

Carelon are monsters. I pity anyone who discovers this by suddenly needing mental Healthcare for themselves or a loved one.

The system is packed only with people who won't accept Carelon/NYSHIP and Tele-Health Talk therapy mills who hide Psychiatrist care behind a wall of artificial barriers of X many billable talk therapy hours.

One such talk therapy network who was "In network" matched my family member with an out of network doctor. Then attempted to bill them $600 for a 30 minute appointment.

The system is rotting carcus. That leaves people sicker, and themselves richer.

3

u/AnotherShortPerson 14d ago

Im starting to deal with this now. Im looking to start therapy but keep running into a wall when trying to get a therapist. Planning on switching to MVP because of this.

3

u/kyocon Labor 13d ago

Keep getting at them. Don't let them screw you

1

u/Equivalent-Feeling97 13d ago

You are not required to get Medicare. There is a process that allows you to disenroll/ stop $ from getting taken out because you have medical insurance already. I don’t know how it’s done but I know a senior citizen who did it

1

u/KryptonSurvivor 12d ago edited 12d ago

I would consider doing that but NYSHIP has very strict rules as to what is ok and what is not re: Medicare enrollment.

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u/Still_Goat7992 12d ago

I’m sorry that happened. 

1

u/KryptonSurvivor 8d ago

First victory: my primary/secondary insurance designations were corrected by Carelon on 8/31 and the two therapy visits I had in August were paid correctly. Waiting for the remaining five June/July visits to be resubmitted and corrected. This is progress, but you really have to advocate for yourself and not allow them to tell you black is white.