Med supp billing flow

Feb 28, 2008

  1. Winter_123
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    Winter_123 Guru

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    Follow up to a question I asked a while back:

    Say frinstance a client goes to see the doc and then there is a copay. Client has Plan F or whatever.

    My understanding from earlier discussion is that the doc's office sends the bill to medicare and then medicare pays and then sends a bill to the med supp carrier for the copay or deductible. Is this correct?

    Does medicare then pay the doc for the entire fee or does the carrier send a payment over to the doc for their share?

    From the clients view, are there any instances where the client would be talking directly with the carrier about payment on a bill where medicare has approved payment (assuming client has kept up with premiums)?

    How does all that work?

    Thank you.

    Winter
     
  2. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    AS long as medicare approves payment there should be no reason that the med supp carrier would deny payment. The carrier does pay the doc.
     
  3. ijerome
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    ijerome Super Genius

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    I've been on med-sup several years and all payments are made directly to Docs. Only if there is a cost above medicare allowance, which I think is not allowed in most states, would I receive a statement directly from hospital. I am on a C plan and have never had to pay anything, except my premium.

    ijerome
     
    ijerome, Feb 28, 2008
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  4. Frank Stastny
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    Frank Stastny Guru

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    There are no copays due to the doctor if the patient has a Medicare Supplement. There is a Medicare Part B deductible, however, that is not considered a copay.

    With Plan F the carrier pays the Medicare Part B deductible. With other plans, other than Plan C, the person on Medicare pays the deductible. The provider submits the claim to Medicare. Medicare then forwards the claim to the carrier. Medicare also sends an EOB to the carrier. If the Part B deductible has not been met for the calendar year then the provider will bill the patient.

    Assuming the doctor accepts assignment, Medicare will pay 80% of the approved amount and the carrier pays the remaining 20% with all Medicare Supplement plans. However, if the doctor does not accept assignment then the patient is responsible for the additional 15% unless the patient has a Plan F and then the carrier pays not only the deductible but also all excess charges.

    If the doctor accepts assignment both Medicare and the carrier send the checks for their portion of the claim directly to the provider. If the doctor does not accept assignment then both Medicare and the carrier send the checks to the client. The client then has to pay the provider.

    There really is no reason for the client to talk to the carrier. The claim is either paid or declined. There are instances where the claim may be declined because it was coded wrong by the provider. In that case the client or the agent needs to contact the provider and have the claim resubmitted.
     
  5. Frank Stastny
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    Frank Stastny Guru

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    You have never had to pay anything because Plan C pays the Medicare Part B deductible and all of your doctors accept assignment. The cost above what Medicare allows is called "Excess Charges".

    There is no law that I am aware of in any state that requires that a doctor must accept assignment.

    All hospitals accept assignment so there are never excess charges.

    I think if you will look at the premium you are currently paying for plan C and compare it to either a D or G you will discover that you are paying considerably more just to have the insurance company pay your Part B deductible. Of all the Med Supp Plans available, Plan C would be the last one I would recommend.
     
  6. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    I have had to call medicare when the provider codes it wrong.
     
  7. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    I agree 100,000%
     
  8. Frank Stastny
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    Frank Stastny Guru

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    Medicare is a pain in the ass to talk to. Medicare isn't the one who screwed up, it is the person in the doctors office or at the hospital. Even if you call Medicare the provider still has to submit the claim again only coded correctly.

    The provider screwed up so I go directly to the provider and have them straighten it out. I have never had to call Medicare to get a claim recoded correctly.
     
  9. Winter_123
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    Winter_123 Guru

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    Alright. Good deal. Thanks.

    Winter

     
  10. senior-advisor-indiana
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    The provider always tells me to call medicare. I guess next time I will just tell the provider I already talked to Frank at medicare. :)
     
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