OneExchange improving Med B process

The Ohio Public Employees Retirement System continues to work with OneExchange, the administrator of the OPERS Medicare Connector, to improve the reimbursement process for Medicare Part B payments.

OneExchange recently conducted a review of Medicare Part B claims that were denied during the first three months of 2016. OneExchange asked PayFlex, its HRA administrator, to determine if some of the claims could be paid out based on a new process.

The examination found that about half of those claims could be paid out as submitted without retirees needing to provide any more documentation.

OneExchange will call those OPERS retirees who still have a denied Part B claim. The claim could be denied because of missing documentation, lack of signatures or similar reasons. The goal of the calls will be to help retirees resubmit the claims so that they can be approved and paid.

We recently published a blog and a video that can help Connector participants be reimbursed for their Med B premiums.

As a reminder, OneExchange offers the following tips:

  • If you want to be reimbursed for your spouse’s expenses, you still need to list the retiree’s name (not the spouse’s name) at the top of the recurring claim form or the reimbursement claim form.
  • The Centers for Medicare & Medicaid Services coupon, statement or Social Security deduction statement that retirees submit as proof of payment needs to contain the following information:
    • The benefit recipient’s full name or the spouse’s full name
    • The type of Medicare being purchased: Medicare Part B
    • The amount of the monthly premium
    • The current year
  • Make sure to subtract the amount that OPERS is reimbursing for the Med B premium before submitting the reimbursement claim to OneExchange. This year that amount is $31.81, and it applies only to retirees, not to spouses of retirees.

Michael Pramik

Michael Pramik is communication strategist for the Ohio Public Employees Retirement System and editor of the PERSpective blog. As an experienced business journalist, he clarifies complex pension policies and helps members make smart choices to secure their retirement.

Michael Pramik

Communication Strategist

  • One Exchange called me this week to inquire about “problems I had receiving my Part B reimbursements.” I had been denied for recurring when I submitted it in January but after OPERS said it could be recurring I resubmitted the same documentation and have received it with no problems since May.

  • I am a spouse of a retiree and have had nothing but problems with One Exchange. One person tells you to do something, you do it and the next person blames you for doing what you were told to do in the first place. This company (One Exchange) is the most useless corporation I have ever been associated with.

    Spouse of Eric Schram

  • Why do I have the feeling the 80 plus year old that worked twenty nice years under PERS just doesn’t
    matter anymore.??? Have we been around too long to take into consideration and do we have to pay
    the price for still being around? One Exchange picked out a health plan for me after four hours on the
    phone with the Advisor. I will now pay over three times the amount for my new health plan in July. I
    guess I’m lucky to still be here to pay it. It’s all been a nightmare !

  • Like so many others, I too experienced problems at first. Since February I have had no problems and have found One Exchange to be very efficient and provide an excellent paper trail to make record keeping easy and accurate. I am very satisfied and would encourage members to explore and familiarize theirselves with the web site.

  • I want to commend One Exchange for the easy transition involving the HRA accounts. I have had no problems whatsoever and have made several claims that have been approved. My necessary funds have been withdrawn and deposits made accurately. Paperwork is always received promptly indicating when deposits are put into my checking account for premium withdrawal or any other medical claim.
    It is good to be able to have an on-line account with One Exchange where I can go and get all the information I need regarding deposits/withdrawals and balance in my account.
    I am well pleased with the way things are being done.

  • I have had no problems at all for all the reimbursements that I have filed. Have had no denials and they have been efficient about keeping me informed about deposits and balance on my account. I am well pleased so far.

    • Glad to know there’s at least one other person in this state that understands one of the main contributors to our current chaos. We may have been able to wlithstand some of the affects of the 2007-2008 collapse (Clinton-Bush NINJA) and cutbacks in OPERS employment.

  • OneExchange told me on 7/12/16 that OPERS did not give them the retiree bank info for the HRA enrollees who were transitioning effective 7/1/16

    • That is correct Gordon. If you would like to sync up your bank account information, please fill out the direct deposit form included in the packet you should have received and mail back to OneExchange. If you have any questions about account set up, please don’t hesitate to call OneExchange at 1-844-287-9945.

      Thanks for sharing your feedback,

      -Ohio PERS

  • Why is medical mutual holding my payments for 3 to fo ur months before automatic deposting the money back to my account? I called MM and the office one exc said they have the right to do so? Now I under stand that I can get repaid for the money deducted from my ss for part b ?No one has ever cotacted me explaining what is and what is not? I have sent all the paper work one exc requested but I feel they fail to care. One office gets the form it needs and the others do not./
    Also the reception desk still ask for SS and date of birth before allowing you to talk to a rep. There has got to be a better way of treating the retired people that paid your wages/

    • Mr. Burns, Medical Mutual doesn’t deposit money in your account. OneExchange coordinates that and transfers your MM monthly payment from your Health Reimbursement Account to your checking account or sends you a check. If you signed up for automatic payments when you picked your insurance then the reimbursements should be automatic each month. We were told that we could be reimbursed for our Medicare payments from the beginning. You can set that up as a recurring reimbursement. I’m imagine they ask for our SS# and date of birth each time we call so that they know they have the correct person on the line and so they can look us up on their computer. Do you have anyone who can help you sort this out? Good-luck.

  • I submitted claims to OneExchange for the medical, vision, and dental payments that I had made through the first 6 months of this year for myself. I uploaded the OPERS pdf file that states clearly on it that it is the documentation that OneExchange should accept. All three claims were denied!!!! Now the OneExchange website has been “upgraded” and will no longer accept uploaded documents. I have been forced to appeal by snail mail as a result.

    In addition, OneExchange denied my recurring Medicare B claim. In that case I did not provide quite as much documentation as I now know they “need”, but nowhere on the online claim process did it state exactly what they needed.

    Not related directly to OneExchange, but OPERS claims they need 45 days to review the paperwork (4 pages) to reimburse the Medicare A premium!

    It just seems that OneExchange and OPERS did not coordinate this transition very well at all.

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