Medicare + Med Supp = Billing Question ?

[goillini52]

While waiting for replies and trying to figure out things, I called UHC again.

She told me that the first claim normally needs to be done manually - i.e., crossover "doesn't work" on initial claim when provider just bills Medicare - provider needs to bill both.

This was news to me (and doesn't sound 100% accurate). And because the provider just billed Medicare, and didn't bill UHC, she said that the crossover was not "triggered."

Sounds like a load of crap. I always tell clients that the Med Supp company doesn't want the provider billing them, as Medicare will be doing that.

When switching them to a new company, I tell them that it's common courtesy to show the Doctor's office your new card, but that the new company will get their claims whether the Dr. knows who your Med Supp is with or not, as Medicare has it on file and will forward the claims to the new Med Supp Company.. Once in a very great while I'll have to file the 1st claim on the new company manually, but hardly ever.

Have you ever had any other clients with UHC that had to file the 1st claim manually? I don't handle UHC, but it sounds like whoever you talked to doesn't have a clue.

 

[sshafran]

Have you ever had any other clients with UHC that had to file the 1st claim manually? I don't handle UHC, but it sounds like whoever you talked to doesn't have a clue.

No, I've never run into this with any carrier.

That's why it sounded inaccurate. But, I figured, who knows, maybe it's true?

 

[kgmom219]

No, I've never run into this with any carrier.

That's why it sounded inaccurate. But, I figured, who knows, maybe it's true?

I have, but only if the application was done after the crossover file was done.

BCBSTX feeds the apps to Medicare on the 3rd Saturday of the month. So any apps submitted after that aren't going to have crossover until the next month.

I have no clue when this carrier does crossover and they probably wouldn't tell you, anyway. However, they are giving you the runaround. It sounds like to me that they had an issue with the crossover file and don't want to admit it. So they told the reps to say "this is how it normally works". OR if it was an "emergency app" which I define as anyone who does their app after the 15th for the next 1st of the month, it may have missed the crossover file.

The client needs to call Medicare to confirm that crossover was completed. You can't do that. And let them know that until the crossover is done (and it may take a month) that there are going to be claim issues.

 

[Todd King]

No, I've never run into this with any carrier.

That's why it sounded inaccurate. But, I figured, who knows, maybe it's true?

And it is very inaccurate. Whoever you spoke with needs remedial training!

 

[vic120]

Mainly because the carrier rep that I spoke to was... how should I put it... Not very helpful. She told me that "all she could tell me" was that they did not get the bill to pay the claim. She could not "guide me on how to fix it" as it's a "third party issue." So, I asked, but she didn't answer.



Thanks - sometimes it's helpful getting the consumer/end-user perspective.



It's UHC - so no problem there.

With UHC I find I can call 5 X in a row get a different person on the phone each time and get 5 different answers each time, So I am not surprised by your experience

 

[somarco]

Whoever you spoke with needs remedial training!

If only there was someone here on the forum who could train them. Someone who doesn't have a license and has never sold a policy.

Maybe Monkey Man can come up with a name.

 

[goillini52]

If only there was someone here on the forum who could train them. Someone who doesn't have a license and has never sold a policy.

Maybe Monkey Man can come up with a name.

I asked me, and as usual, he doesn't have a clue.

 

[somarco]

I asked me, and as usual, he doesn't have a clue.

I thought you had a license.

Was it revoked after the CMS police saw the granny porn on your computer?

 

[goillini52]

I thought you had a license.

Was it revoked after the CMS police saw the granny porn on your computer?

No, after I got busted for pot.


Hey, how did you know that I watch granny porn?

 

[somarco]

how did you know that I watch granny porn?

Doesn't everyone?