Can doctors refuse Med Supps from certain carriers?

[MrSockMonkey]

Hi. Neighbor told me today his pension plan is changing Medicare options. One he could choose (paid for by company) is Plan F with a major carrier. (I asked him to get info on what else they offer as an alternative, because Isn't Plan F the best of the best?). This is a Florida resident.

Question....his sister told him that this major carrier is not accepted much in certain areas, like where she is in S. Florida. She said she saw signs in more than 1 doctor's office stating they aren't "taking" this carrier's insurance.
Is this possible? I thought it didn't matter with the supplements....not like with the Advantage plans.
I will appreciate any insight into this. Thank you.

 

[Chazm]

I would tell them just to give the doctor her Medicare card and be done with it.

 

[sshafran]

I guess anything is possible, but most likely, here is what's happening.

There is a "carrier x" which sells mapd and med supps. The doc doesn't take carrier x mapd.

When it comes to carrier x med supp, that's secondary insurance (original medicare is primary). Key question is: do you take original "regular" medicare?

If the doc does, then all is good as the bill will get routed to the supp carrier to pay via the crossover.

 

[MrSockMonkey]

Thanks Chazm and sshafran....I am still very new and have focused more on MAPD because in central Florida they sure do like those plans. I have only sold one supp, a Plan F, and wouldn't you know it....the first time the guy goes to his doctor with his very first Medicare visit, he has to pay $157 out of pocket because his doctor doesn't accept Medicare assignment. He calls me and asks what is he paying all this money for...I told him he will get reimbursed, and now he thinks he wants MAPD instead.
Back to the subject at hand....so do you mean when one goes to a doctor who accepts Medicare assignment, they don't have to bring their supplement into the equation at that time? That this all works in the background? I don't understand...please help. Thanks.

 

[sshafran]

Back to the subject at hand....so do you mean when one goes to a doctor who accepts Medicare assignment, they don't have to bring their supplement into the equation at that time? That this all works in the background? I don't understand...please help. Thanks.

Correct. The provider bills medicare, then medicare sends the bill to the supplement carrier.

At least 99% of the time it works like a charm.

Now, it doesn't hurt for them to give the provider their med supp card, but its not absolutely necessary.

 

[goillini52]

Thanks Chazm and sshafran....I am still very new and have focused more on MAPD because in central Florida they sure do like those plans. I have only sold one supp, a Plan F, and wouldn't you know it....the first time the guy goes to his doctor with his very first Medicare visit, he has to pay $157 out of pocket because his doctor doesn't accept Medicare assignment. He calls me and asks what is he paying all this money for...I told him he will get reimbursed, and now he thinks he wants MAPD instead.
Back to the subject at hand....so do you mean when one goes to a doctor who accepts Medicare assignment, they don't have to bring their supplement into the equation at that time? That this all works in the background? I don't understand...please help. Thanks.

Somethings not right. I can't imagine how someone would owe $157 in excess charges from an office call. I'm betting it was for something Medicare didn't cover, or the Dr's office coded it wrong. Look at your client's EOB from Medicare.

You might have to file it manually for him.

 

[MrSockMonkey]

Correct. The provider bills medicare, then medicare sends the bill to the supplement carrier.

At least 99% of the time it works like a charm.

Now, it doesn't hurt for them to give the provider their med supp card, but its not absolutely necessary.

Thank you so much, sshafran!

 

[MrSockMonkey]

Somethings not right. I can't imagine how someone would owe $157 in excess charges from an office call. I'm betting it was for something Medicare didn't cover, or the Dr's office coded it wrong. Look at your client's EOB from Medicare.

You might have to file it manually for him.

Hi goillini52. This was just a normal check-up office visit. He had gone to this doctor for 20 years, using his employer coverage. Never paid a dime, just showed his (same carrier!) card. Newly retired, he goes with Plan F. I called the doctor's office myself....woman says doctor has been there 30 years and has never accepted Medicare assignment. They did file for the reimbursement for this fellow, though.
Then I went to the doctor's info on a couple health sites and saw most insurance he "accepts" are group plans. So all is good now but wake-up call for new member and for me. Just because you are paying for the "best" still doesn't mean always clear sailing.

 

[LostDollar]

Correct. The provider bills medicare, then medicare sends the bill to the supplement carrier.

At least 99% of the time it works like a charm.

Now, it doesn't hurt for them to give the provider their med supp card, but its not absolutely necessary.

It is when the doctor's billing clerk says you must provide it.

 

[MrSockMonkey]

Also good to know, LostDollar. Thanks.