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Can secondary insurance pay claims that are denied by Medicare?


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Wiki User
2015-07-15 20:45:07
2015-07-15 20:45:07

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).

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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.

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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.

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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.

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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.


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