That would be covered under the terms of your policy. In general that is what supplemental, (secondary) insurance is primarily for.
Most "supplemental" plans pay the 20% that Medicare didn't pay only AFTER seeing an "explanation of benefits" statement--i.e. proof that Medicare paid their part. If Medicare denies a service all together, the supplemental plan is often under no obligation to pay at all, as they are there to "supplement" Medicare, not take the place of it in cases of denial. This is especailly true if Medicare denies because the service was deemed "not medically necessary".
So, in short, no. Medicare supplements often do not cover services if they are denied by the primary (Medicare).
As long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The secondary insurance will only cover the expense according to your plan.
A Medicare attorney is the best choice for general Medicare claims. If you specifically have a claim that has been denied, there are even lawyers who specialize in denied claim cases, frequently referred to as denied claims attorneys.
appeal to secondary insurance
all depends on the blue cross plan you have. A lot I come by through my job as an insurance biller the secondary will pick up any copays that medicare wouldn't cover. But there is some plans that won't pay if medicare doesn't pay. So, really, yea, your secondary should pick up some cost. Unless it is just co-pays, they have the choice to make that your responsibility as a member. Do take the time to figure it out, a lot of times if you don't fight your own claims, you pay much more than you need to. Always keep and look at your explanation of benefits that you should receive from the insurances after each visit explaining what they paid and what they denied and what you owe. Anything that is not listed in the "Allowable Amount" column, you are not responsible for. Especially if the place you attended is participating with that insurance. A lot of companies try to collect for money that was denied by the insurance, but they(the insurance) states you are not responsible for.
Relying on insurance can become a problem as various insurers may not pay claims. Time spent challenging denied claims also becomes costly for individuals as well as companies.
The EOB (Explanation of Benefits) is what explains Medicare's payments and denials. Sometimes it is referred to as an EOP (Explanation of Payment). This document will show all items filed on a particular claim for a particular provider. It will show which items were covered or noncovered and why, which items were denied and why, and which items were paid. It will also show the patient's responsibility as far as deductible and coinsurance goes. If the patient has a Medicare supplement or just a secondary plan and Medicare is aware who you have chosen, they will "crossover" the claim to the secondary. This means they will automatically send a notification to the secondary payor to let them know how much Medicare allowed (the total amount the provider should receive from Medicare, other insurance companies and the patient), and how much is being left to the patient/secondary.
Some people opt for discount car insurance and they get discount insurance coverage, claims can take a while to process and sometimes denied more frequently
Yes, subject to the limits in their policy. No. With most insurance policies, there is what is called a timely filing limitation. For my company; contracted providers have 6 months, and non-contracted providers have 12 months to submit the claim. If your primary insurance received the claim within timely filing, you may have the option of submitting the claim to your secondary with proof that it was filed in a timely manner. If that doesn't work you can always appeal the decision with the secondary or for that matter the primary insurance company. Policy holders are not responsible for claims that deny for timely filing.
What kind of Insurance?
can a person be denied medical servises due to no insurance
Many insurance companies will denial claims for pre-existing conditions. You have a right to appeal all claims. You should call your company first to see why the clam was denied.
Yes, you can be denied Medicare coverage even if you are a citizen of the United States. Having an income higher than Medicare's current guidelines can disqualify you. There are many other reasons which are all described on the government's Medicare website at medicare.gov.
An insurance denial attorney will fight for you, should your claim be denied by your insurance carrier.
No. The primary insured MUST match who owns the vehicle, otherwise any claims made for that vehicle will most likely be denied.
Medicare denied the shingles vaccine for me. I had the vaccine in January 2008. I do not have Medeicare Part D, just A and B. My "coordinated" insurance also denied the claim. Nichole S October 10, 2007 8:48 AM You may want to check with Medicare about this. I found this info on the web: For patients over 65, Medicare will begin paying for the shingles vaccine in January, 2007 - but not the way it pays for the most widely used adult inoculations, flu shots, which are fully covered. Instead, the shingles vaccine will be treated like a prescription drug, with varying co-pays depending on a patient's drug plan.
While I don't have the numbers for you, for the most part the money Cigna uses to pay claims is not from their revenue at all. Most employers maintain a bank account of their funds which Cigna uses to pay claims. This is referred to as A.S.O. (administrative services only) funding. Cigna's pocketbook is not impacted by the claims paid or denied for these accounts, which make up the vast majority of their claim volume. In fact, paying a claim is less costly than denying a claim, as no one calls the insurance company regarding the claims that have been paid, just the ones denied. So the more claims denied, the more customer service agents Cigna must pay for. The financial incentive is actually to pay claims rather than to deny.
It depends on how the service is coded on the bill the doctor's office submits to Medicare for payment. If it is coded "routine venipuncture (36415)", Medicare will pay $0. Medicare Supplemental insurance will also pay $0, since Medicare denied the claim for this service. The patient will be responsible for paying the full amount, typically around $20-25. However, if it is coded "routine venipuncture for collection of specimen (G0001)", Medicare will pay the doctor, usually around $3, and the patient's responsibility will be $0. It helps if you ask your doctor or doctor's nurse to check to make certain the procedure is coded as G0001.
Go to court! If insurance is involved, let the insurance handle it and the insurance adjusters handling the case can make determination of injury based on speed and point of impact on a vehicle. If either insurance company denied them payment for injury, and they decide to sue you instead, they will have to back up their medical claims in a court of law. This typically includes things like: medical reports, x-ray results, CAT scan results, blood tests, etc.
This court hears cases in which individuals claim that the Department of Veterans Affairs has denied or otherwise mishandled valid claims for veterans' benefits.
That's funny,, No.... If you have been denied a claim, then no settlement is forthcoming. It's been denied. Please see Websters Dictionary , look up "Denied"
you go get a lawyer . :)
This medicare program is only for local payee only this is why you are not getting approved.