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Yes, Medicare can provide coverage if the primary insurance denies a claim, but it depends on the specific circumstances. Typically, the provider must submit the claim to Medicare after the primary insurer has processed it. If Medicare determines the services are covered under its guidelines, it may pay for the remaining balance, but patients should verify their eligibility and any potential out-of-pocket costs. Always check with both insurance providers for specific details regarding coverage.
What else can I help you with?
If primary insurance denies coverage and you have secondary who is responsible to pay the bill?
== == If secondary insurance denies coverage, YOU get to pay the bill. == ==
Can secondary insurance pay claims that are denied by Medicare?
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).
Do you obtain a authorization for secondary ins when medicare is primary?
after getting the payment from medicare (Primary) then secondary (X/Y/Insurance should pay even if there is no auth. And only this happens if secondary insurance follow medicare guidelines.
Who pays for cpap equipment you have bcbs and Medicare?
The primary will pay first. If the primary happens to be traditional Medicare.......They (MedicarePart B will pay 80%) and the Secondary should cover the remaining 20%. That is after your annual deductible of $165.00 has been met.
If your primary insurance denies a claim for failure to have a referal will your secondary insurance pay the claim?
Read your policy
If medicare is secondary will it pay the primary co pay?
AnswerIt depends on the allowed amounts. Even if it does pay something it will never pay the entire copay.
If you have Medicare benefits and employer benefits which is primary?
Medicare is primary.
Who is the primary payer when member has employee group and medicare?
Generally, Medicare is primary.
If a patient has medicare primary bcbs secondary medicaid tertiary and medicare pays bu t bcbs denies for carve out Is medicaid now responsible for balance?
You would need to check the medicad policy if the claim is covered or if they will be the 3rd party insurance payee in this case.
If you are over 65 and have Medicare and medicaid is Medicare always primary?
Yes, Medicare is primary. Medicaid is always the payor of last resort.
I understand when Medicare is primary and when Medicare is secondary. What is the difference in coverage between a Medicare Supplement and Medicare as a secondary insurer?
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.
Do all retirees pay the same for medicare?
Medicare beneficiaries pay premiums (most people do not have to pay a premium for Medicare Part A); also, working retirees pay Medicare payroll tax.
