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Do you have to pay the medicare deductible if they are paying secondary to a primary insurance carrier?


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2011-01-14 00:57:58
2011-01-14 00:57:58

Every covered life, whether utilizing Medicare as primary or secondary insurance is subject to the same, annual Medicare deductible.

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No. If you have a deductible with your primary carrier, you will have to pay the deductible first before Medicare will pay anything.

You are correct that Medicare does not cover Acupuncture at this time, and that a "For Denial Purposes Only" letter must be obtained and sent to the secondary insurance carrier as long as the secondary carrier covers Acupuncture performed by a Licensed Acupuncturist in the state where services have been provided.

The Medicare administrator varies from State to State.

By law, no, but Medicaid and/or your private insurance carrier might insist that you do so.

A deductible is your "skin in the game" so to speak. A way of reducing insurance premiums is to increase you're deductible, thereby reducing the risk of the insurance company. If you had an insured loss of $1000 and you had a deductible of $250, you would be paid $750 by your insurance carrier.

The patients responsibility is the dollar amount indicated on the MRN (Medicare Remittance Notice) due to the doctor (rendering provider). This amount is typically 20% that Medicare does NOT cover, and solely the responsibility of the patient when one has Medicare as their primary health insurance carrier, and NO supplemental or secondary insurance. By law the patient MUST pay this 20% co-pay amount indicated by Medicare. The patients responsibility amount may vary according to the level of visit, or deductible due, all indicated by their insurance. If a Medicare member has any questions regarding how much they owe to a doctor at any time, they should call the number located on the back of their Medicare identification card.

Medicare is paying only 80% of the approved amount the patient is being billed. The responsibility for 20% of the Medicare approved amount will be transferred to the secondary insurance carrier.

Quite often, when the other carrier has accepted liability but you have had your damages taken care of by your own carrier, the at-fault carrier will agree to send you your deductible. Any of you can call the at-fault carrier and request this, though they'll need proof from your own carrier as to what the deductible is. If, however, there's a liability dispute between your two carriers, you'll have to wait until your carrier subrogates and/or arbitrates the other carrier. All this means is that your carrier will ask for their money back, including your deductible, and if the other carrier declines, your carrier will initiate arbitration. Your carrier may or may not win; if they do, they get their money back and can send you your deductible.

No, but your private insurance carrier might require you to do so.

Medicare does not require you to use it as your primary insurance; however, your private health insurance carrier probably will, especially if your employer is paying for your health insurance.

Yes, if his private insurance carrier will let him.

The vandal if the can be found and sued. Otherwise your insurance if you have full coverage. You will pay a deductible and recover the deductible if the vandal is ever found and successfully sued by your insurance carrier.

Yes, you can be covered by multiple dental policies. There will be one insurance carrier as your primary insurance and the second insurance carrier will be your secondary insurance.

No; however, your private health insurance carrier probably will require that, especially if your employer is paying for your health insurance.

After you have received the Explanation Of Benefits (EOB) from your primary carrier if there is coordination of benefits. If the secondary insurance is an indemnity you do not need to wait.

No, they must inform you of changes to the insurance contract. However, if they sent notice, they will usually have file information on when and where sent.

There is no law requiring this; however, your private insurance carrier will probably require it.

If you decide to go through your carrier -- and assuming your policy doesn't have a provision for waiving your deductible under these circumstances -- then, yes, you'll have to pay your deductible.Your carrier will then pursue the at-fault party for all monies paid, including your deductible.Keep in mind that applying your deductible has nothing to do with liability. It doesn't matter if your car was parked and unoccupied, or if you were rear-ended. Rather, the deductible is the portion you agreed to pay in the event of ANY loss, regardless of liability.If the at-fault carrier agrees to pay for the damages (which they should, given the facts-of-loss), then you're correct: You wouldn't pay your deductible.Your deductible applies only if you're going through your own carrier, and even then, the at-fault party still owes for ALL the damages. By avoiding your own carrier, you shouldn't have to pay out-of-pocket for any of the damages.Also, if you do decide to go through your own carrier, they might waive your deductible if they confirm that the at-fault driver has active insurance, and if they confirm that the other carrier is willing to pay.A personal experience:When I called my insurance company about this, they told me that if the at-fault person's insurance company (I'm assuming they're at fault since they hit a parked car) assumes liability (again, since they're most likely liable) they'll cover the damages and I won't have the pay the deductible. Did I hear this wrong? Also, I live in Pennsylvania, and from what I hear our insurance laws are a little goofy.

If on medicare you can't, b/c social security will deduct b/c you get your payment. If you have a supplement or mapd policy call insurance carrier

It the wife has her husband on her work insurance plan than that is his primary insurance. If he is not covered on her plan then he would need to buy his own insurance. Once he gets on Medicare that would become his primary insurance. If his wife is still working once he gets on Medicare the primary carrier is determined by how many people work for her company. If there are less than 100 employees then Medicare would be primary.

Medicare does offer coverage for skilled nursing facilties. In order to find out if Medicare will pay as your secondary, the provider needs to submit it to Medicare. This statement is from the website: Medicare providers must submit claims (bills) to Medicare for you, whether Medicare is your primary or secondary insurer. For Medicare to process a claim as a secondary payer, the provider must give your primary insurance information to Medicare. You may also consider calling 1-800-Medicare for information about secondary coverage. If you do, remember from Nov 15th to Dec 31st is a busy time for Medicare so it may be difficult to reach them. One more hint to save some frustration: If BlueCross BlueShield has already paid the amount they were supposed to pay, calling them won't really help you because their job is done. Now the remaining bill is between the provider and Medicare.

In most cases no. You can not chage due to better coverage. 90% of insurance companies, if not more, have what is called a birthday rule. Meaning if you have dependant children on the policy the guardian who was born first (or who is older) is the primary carrier for the dependant children and the younger of the two guardians is the secondary carrier. If you were to have coverage through yourself and a spouse you would be your own primary, as would your spouse be their own primary. If you are the carrier for both insurances then it would all depend on your plan provisions and restrictions, in which case you would have to question each insurance company as to how they would handle determining what insurance is primary and what insurance is secondary.

That depends on your insurance.If you have Medicare you do not (unless you are enrolled is a "Medicare Advantage Plan"). Most PPO's do not. Almost all HMO's do require a referral.If you have any doubt you should call your insurance carrier.

I think not. It seems unlikely that a provider would be limited to the rates of an insurance carrier, such as Medicare, of which the patient is not a member.

Well, if they are going to pay the deductible directly to your insurance carrier and they except that, and pay for the claim themselves, it has nothing to do with you or your policy This question is a little open ended, but if you have reported the incident to your insurance and your going to accept the rest of the cost of repair out of your own pocket then their "deductible payment" would really just be viewed as a payment on your policy. Further lowering your next renewal cost or sometimes if you owe nothing the insurance my give this back to you. This would not be reflected necessarily as a claim issue.

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