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Bertha Mire’s Story

How a Small Flag in the Medicare System Caused Big Frustrations

I worked as a nursing home administrator in Louisiana for many years. About 5 years ago when I was 64, I slipped and fell in the hallway of the nursing home. As a result, I needed surgery on my shoulder, which was thankfully covered by worker’s comp insurance.

I was away from work recovering for about six months, and then returned for several years until retiring at age 68.

Last year, I needed stomach surgery that was completely unrelated to the fall I experienced at work several years before. Meaning, it should not and would not be covered by workers comp.

Oddly enough, doctor after doctor I saw for in preparation for the surgery told me that Medicare would cover the stomach surgery, but workers’ comp was still in the system as the primary payer. I was very confused as to why workers’ comp was involved at all.

After being a nurse for 48 years, a flag on my Medicare account, caused by an unrelated workplace injury, led to months of confusion as I went through the process of bloodwork, x-rays and other surgery prep while being told workers’ comp was still my primary form of payment.

I knew this should not be the case, but what was I to do?

After many frustrating months, one of my providers was able to reach Medicare to ensure them that the Medicare Secondary Payer laws did not apply in my case, and that Medicare was responsible for my stomach surgery and the procedures leading up to it.

The stress from being unsure how my bills would be paid was very unsettling and I will continue to advocate for change so that other Medicare beneficiaries do not go through anything similar.

The unfortunate issue Bertha faced with Medicare flagging her file due to an outdated, unrelated worker’s comp claim is all too common among Medicare beneficiaries across the country.

You and your stories matter. If you have a story like Bertha’s and are willing to share it, please contact the MARC Coalition so we can help advocate for change!

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