== == If secondary insurance denies coverage, YOU get to pay the bill. == ==
If the provider is out of network or not contracted with the secondary insurance, they do no have to bill the secondary and the patient is responsible for the balance (if any) owing
Blue Cross Blue Shield is primary and Medicare is secondary they will the BCBS first and then bill Medicare.
Medicare would have covered all the remainder if my insurance had not made the error "Can they rebill medicare again I received a bill from the hospital almost 2 years after spouses death because insurance company made a mistake am I responsible because medicare should pay rest?"
Medicaid is always the payor of last resort. Before a Medicaid agency pays a bill for a Medicare beneficiary, they require documentation that Medicare has "adjudicated" the bill (i.e., decided whether to make payment and, if so, how much).
You submit an EOB from the Medicare HMO with your Medicaid claim.
Yes. Your doctor is not required to file to your secondary insurance.
This is directly from the Medicare and You 2009 Book: When you have other insurance, there are rules that decide whether Medicare or your other insurance pays first. The insurance that pays first is called the "primary payer" and pays up to the limits of its coverage. The one that pays second, called the "secondary payer," only pays if it covers any of the costs left uncovered by the primary coverage. If you have other insurance, tell your doctor, hospital, and pharmacy so your bills get paid correctly. If you have questions about who pays first, or you need to update your other insurance information, call Medicare's Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782. You can view the details here: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf
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 Meidcare.gov 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.
Yes, under most circumstances it will. Medicare has a set amount for these types of services, no matter what they charge. Medicare allows the provider to bill a certain discounted amount to the patient or insurance company. www.texasbestmedicare.com
Yes. If your name is on anything you are jointly responsible for a bill and vice versa.
You will bill medicare as primary and the supplement secondary. Usually if filing a HCFA 1500 electronically if the supplemental policy is on the beneficiaries Common Working File with Medicare it will automatically crossover to the supplemental policy. Hope this helps....
Once Medicare has "adjudicated" the bill, MediCal's payment will be based on their policy and the patient's eligibility on the date of service.
Here's a basic example of how secondary health insurance works. You go to the doctor, he charges you $100 for the visit. Your primary insurance pays him $50 and disallows $10. The remainder of the bill, $40, then either comes to you to pay or to a secondary insurance. In most cases the secondary will pay most, if not all of the $40.
There is one major difference between these types of claims. When a person has two different insurance carriers, one of them is designated as the primary coverage and the other as the secondary. The primary insurance should be billed first and normally pays the bulk of the bill. The secondary insurance gets billed for the remainder of the bill which the primary insurance did not pay for.
If you have a Medicare Supplement then the provider will bill Original Medicare first. At that time Medicare will pay the allowable amount and then return an explanation of benefits stating the beneficiary's portion. Based on the Medicare Supplement Plan that is in place (A-N) the Medicare Supplement will pay a portion or all of the remaining amount due. If they pay only a portion based on the plan (A-N), then according the plan guidelines, the beneficiary would pay any outstanding amount at that time. If a Medicare beneficiary is covered on a employer or retiree group plan and due to the size of the plan, the group plan is primary, then the group plan benefits will apply first and any amounts due by the Beneficiary will be billed to Medicare second. If it is a Medicare covered service, then Medicare will pay the remaining amount due as the secondary payor up to the amount allowed by Medicare. If the service is not allowed by Medicare, than the beneficiary's co-insurance or co-payment under the group plan would be their responsibility.
It's the provider's office responsibility to forward the bills to the correct insurance for payment. When using Medicare along with a Medicare Supplement, you'll show both your Medicare Card and your Supplement insurance company's card at time of payment. The provider's office will bill each card accordingly.
pay a higher deductible
I will use for example someone on MEDICARE. They have paid into their medicare insurance and have both parts (thus eliminating confusion of part a, part b). First the bill is sent to the Medicare insurance provider, who will have an allowed amount and then of that what they will pay. The billing medical source credits what MEDICARE paid and then submits the balance to the 2nd or CO-INSURANCE. As a whole, if MEDICARE pays 90%, the CO-INSURANCE picks up the balance of 10%. These figures were used as an example. You will have to know your own breakdown of what percentage is paid. Remember is is on the ALLOWABLE or APPROVED amount, not the whole billing. Most insurance such as MEDICARE and personal insurance through a work place, have a provider adjustment. Then the % is taken from there. PRIVATE holders of medicare and co-insurance my not have the luxury of an adjustment of cost. And will have to cover what is left.
Why not? What are the terms of the 2nd Insurance?
I'm not familiar with UMWA health insurance, but most private carriers expect providers to bill Medicare first.
Providers and hospitals that are in your insurance companies network will not come after the patient for costs over the negotiated allowed amount for the services they provide. Providers and hospitals can try to collect from you if they are not in the network (even if your insurance company has paid for some costs) or if some of the services are not covered by your insurance company, or if you are over the benefit limit for those services. Also, providers and hospitals can collect coinsurance costs that you haven't yet paid. If Medicare is secondary than unpaid costs would fall to them but the same rules apply. Potentially some services are not covered by either.
yes: this is called an ABN, or advance beneficiary notice. If you receive this notice, the hospital is telling you that they don't believe you will meet Medicare criteria for a procedure. If you sign it, they will still submit the bill to Medicare, but you will be responsible for paying it if Medicare refuses. The best thing to do may be to ask for them to get a predetermination from Medicare: then you will know before hand whether it will be covered or not. Also, it is important to note that this is NOT a valid form for Medicare Advantage Plans. They are not legally binding at all if you have an advantage plan, and if they try to bill you because you signed it, your insurance company will inform them they cannot do that (if they are contracted with your insurance company).
Lyndon Johnson signed the first Medicare bill.