Is Plan N Worth the risk?

[somarco]

It is not your job as the agent to assess the risk. You are responsible for educating your client and making sure THEY understand the risk.

After al. It is THEIR plan and THEIR money.

I am guessing maybe 5% of my clients have an N plan. Could be a little higher. In Georgia the G plan makes a lot of sense especially for those looking at F.

Because of the proximity of Mayo in Jax to south GA residents, I do advise clients in that area to consider G and forget about N. They take my advice.

Of course I would have a south G client that bought a G from GTL and those folks STILL haven't figured out how to adjudicate a claim from Mayo. So glad I didn't write more than a few apps with GTL and wish I had never done those.

This can be a billing nightmare since the client is paid for the services and then the client has to pay the clinic directly.

Never have figured out how they decided it was more profitable to not take assignment.

I have an N plan. My derm takes assignment. I got a bill from them a few weeks ago for a visit last January (2017) for $3.43. Not xs, but my copay. I thought I had paid it but checking my records I see that I did not. Also never found an earlier bill for the amount. Took them a year to figure out I owed them $3.43. Probably cost that much to audit and send a statement.

Not my problem. I paid it online and moved forward.

 

[LostDollar]

I am still getting bills related to a surgery last March. The latest one presents a problem because it appears to be for a service code that Medicare is denying on an EOB, but the online EOB is all asterisks, no dollar amounts. There are 4 EOBs in my account relating to this provider, all have asterisks instead of amounts, but all deny service for this code--but the provider statement suggests they have received payment from Medicare.

The service in question is code 64417 and the provider seems quite determined to collect something for it.

The Medicare supplement carrier says I owe the bill twice, once for my share of medicare allowed amounts I've already paid plus the latest provider billing, and then again for the entire medicare allowed amount from another EOB for the same provider, for the same service, in which Medicare denied payment for all service codes (presumably because they had already processed the service under another claim number) .

It is much more fun to read about you and kgmom solving these kinds of problems than figuring out answers for stuff like this myself!

 

[kgmom219]

I am still getting bills related to a surgery last March. The latest one presents a problem because it appears to be for a service code that Medicare is denying on an EOB, but the online EOB is all asterisks, no dollar amounts. There are 4 EOBs in my account relating to this provider, all have asterisks instead of amounts, but all deny service for this code--but the provider statement suggests they have received payment from Medicare.

The service in question is code 64417 and the provider seems quite determined to collect something for it.

The Medicare supplement carrier says I owe the bill twice, once for my share of medicare allowed amounts I've already paid plus the latest provider billing, and then again for the entire medicare allowed amount from another EOB for the same provider, for the same service, in which Medicare denied payment for all service codes (presumably because they had already processed the service under another claim number) .

It is much more fun to read about you and kgmom solving these kinds of problems than figuring out answers for stuff like this myself!

Tell me again why you didn't buy F or G???

Call the carrier. Find out why they allowed 2 claims with the same date of service, procedure and diagnosis claims to process, instead of rejecting one of them for duplicate.

If that doesn't work, call Medicare.

If they both think you owe it, call the provider for an explanation.

And for the record, this is why I sell G almost exclusively. You can deal with this. But what about at age 90? 95? While dealing with a serious illness?

 

[GreenSky]

It really isn't 15%. It's only 9.25%.

For the doctor it is indeed 9.25%. For the patient they still pay 15% of 95%. So from their perspective they are paying 15%.

Still, not worth paying $40+ per month to cover it.

Rick

 

[LostDollar]

Because I'm really cheap!!

And I thought about Grandma, and your "interview the family comments" too. Although "cheap" was coloring my views, I decided that a considerably younger spouse would probably pass your interview test.

And, although I did have to come up with cash, and might have to do so again this year if I need another surgery, I appreciated having the HDF, rather than N, because I had no worries about getting soaked with "extra" charges from an anethesiologist (which happens to be the provider type processing these bills around 10 months after the surgery was performed.

As far as I'm concerned, Medico dropped the ball by, apparently, automatically assuming that two Medicare claim numbers from the same provider, on the same date, for the same service codes represented two separate services. That's the first error I've had in their paperwork for $40K plus of claims.

I need to see a Medicare EOB with dollar amounts, instead of asterisks, on it - and the same EOB also showing that Medicare approves, rather than denies, this one service code. I haven't quite decided how to get that yet.

 

[Todd King]

Because I'm really cheap!!

And I thought about Grandma, and your "interview the family comments" too. Although "cheap" was coloring my views, I decided that a considerably younger spouse would probably pass your interview test.

And, although I did have to come up with cash, and might have to do so again this year if I need another surgery, I appreciated having the HDF, rather than N, because I had no worries about getting soaked with "extra" charges from an anethesiologist (which happens to be the provider type processing these bills around 10 months after the surgery was performed.

As far as I'm concerned, Medico dropped the ball by, apparently, automatically assuming that two Medicare claim numbers from the same provider, on the same date, for the same service codes represented two separate services. That's the first error I've had in their paperwork for $40K plus of claims.

I need to see a Medicare EOB with dollar amounts, instead of asterisks, on it - and the same EOB also showing that Medicare approves, rather than denies, this one service code. I haven't quite decided how to get that yet.

If Medicare has denied the claims/codes, then get in touch with the provider and let them know they need to refile it under a different code. It's not that unusual for a provider to file under the wrong code and have to refile.

 

[LostDollar]

I have yet to find a hospital that does not accept Medicare assignment.

Just an aside for my personal knowledge, do you know if the KU Med Center takes assignment?

 

[TwoCents]

Because I'm really cheap!!

And I thought about Grandma, and your "interview the family comments" too. Although "cheap" was coloring my views, I decided that a considerably younger spouse would probably pass your interview test.

And, although I did have to come up with cash, and might have to do so again this year if I need another surgery, I appreciated having the HDF, rather than N, because I had no worries about getting soaked with "extra" charges from an anethesiologist (which happens to be the provider type processing these bills around 10 months after the surgery was performed.

As far as I'm concerned, Medico dropped the ball by, apparently, automatically assuming that two Medicare claim numbers from the same provider, on the same date, for the same service codes represented two separate services. That's the first error I've had in their paperwork for $40K plus of claims.

I need to see a Medicare EOB with dollar amounts, instead of asterisks, on it - and the same EOB also showing that Medicare approves, rather than denies, this one service code. I haven't quite decided how to get that yet.

Plenty of CPT code look ups available online.

CPT 64417, Under Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic Procedures on the Somatic Nerves

 

[LostDollar]

If Medicare has denied the claims/codes, then get in touch with the provider and let them know they need to refile it under a different code. It's not that unusual for a provider to file under the wrong code and have to refile.

Thanks Todd.

 

[somarco]

Providers have 12 months from date of service to file a claim. Check your MSN and compare to the carrier EOB. Duplicate claims for the same procedure on the same date should not be paid by you or Medicare. If there are two different NPI numbers that would be confusing, but Medicare should only approve one unless there are special circumstances.

Denied claims can be any number of things, including a service not covered by Medicare. If that is the case and your provider did not produce an ABN form AT TIME OF SERVICE you don't owe the bill.

Your Medigap carrier should only be paying approved claims received from Medicare. Call the folks at 1 800 MEDICARE and ask about the bills. They are open 24/7 except on federal holidays. Generally no hold times if you call at 2AM.