A Medigap Counselor normally deals with issues that relate to the purchases of Medicare Supplemental Insurance policies. They do not deal with the issues that arise after the policy. They are usually hired by the company they represent to sell a policy and do little more. Although they are hired to sell policies, it does not mean they are not knowledgeable about all of the potential problems that can arise with Medicare and Medicaid. Even though they are trained to deal with sales instead of dealing with actual problems, they do know something about how the process works.
You may be wondering how a Medigap counselor can help you, especially if these professionals do not handle the actual claims. Even though they may not have the claims, they know a little bit of how the process is handled. They know when Medicare should pay more than they are and what their company will do for its customers. When a person decides to consult a Medigap counselor, he is often trying to figure out paperwork issues or why a Medigap insurance company chose to deny his claim. The counselor can explain the reasons for denial. He may also be able to tell the client what the client needs to do to appeal the denial. It depends on the individual and what his company will allow him to do.
A Medigap counselor cannot provide help with problems that relate to Medicare itself. If Medicare denies a claim, the consumer must take up the issue with the organization’s governing board. A Medigap counselor also cannot handle issues that deal more with the doctor’s office and its procedures than with his company’s procedures. He may know when a doctor’s office has done something incorrectly, but there are limits to what he can do to correct the situation