Does Anyone Know If It Is Legal For My Health Insurance Provider To Begin Paying Only 20% Of My Medical Bills

[Skeggr]

I was 65 in Oct 09 and signed up for Medicare to begin 1/1/10 for financial reasons. Ins provider tells me that since I was eligible in Oct that is when they became supplemental instead of primary. Now all bills incurred from Oct - Dec 09 are coming to me from providers for payment! This is in VT..so having trouble with resources knowing if it is "legal" or not

[Fflewdwr]

YoBob said: 1 Here's the bottom line. It is in the insurance company's best interest to do the minimum possible(legal or not) and if you dispute it to give you as much run around as possible in resolving an issue in hopes you kill over before they actually have to make things right.Your best defense is a medical insurance advocate. These are professionals who make it their business to see that insurance providers and medical practitioners don't take advantage of their clients. They are worth their weight in gold. I'm sure you can find one in your local yellow pages or using your favorite search engine. It certainly wouldn't hurt to talk to one. 47 months ago

[Keely]

You need to look up your policy and see what your deductible is  and there might have been a 'vesting period' til full coverage takes effect.   Do keep in mind that anything over 7.5% of your annual wage that you pay is tax deductible so make sure you keep receipts for everything, even taxis to and from the doctor and so on. Good luck! wildaboutbooks44 47 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[anthony89]

 and there might have been a 'vesting period' til full coverage takes effect.   Do keep in mind that anything over 7.5% of your annual wage that you pay is tax deductible so make sure you keep receipts for everything, even taxis to and from the doctor and so on. Good luck!

[Nachton]

Well it truly matters what your medicare plan was. Well it truly matters what your medicare plan was. When you set up your medicare plan, depending what your situation was with you at the time it can affect what your plan was.   Everyone who signs up for medicare gets different coverage just like any other health care provider. Theirs fine print with everything; because I dont know the in depth details of your medicare I cannot truly tell you if what they are doing is legal or not, and I am NOT asking for those details thats very personal to you and you should only reveal that to people you trust deeply or perhaps a lawyer. WarrenBlack 47 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Kelyn]

Well it truly matters what your medicare plan was. When you set up your medicare plan, depending what your situation was with you at the time it can affect what your plan was.   Everyone who signs up for medicare gets different coverage just like any other health care provider. Theirs fine print with everything; because I dont know the in depth details of your medicare I cannot truly tell you if what they are doing is legal or not, and I am NOT asking for those details thats very personal to you and you should only reveal that to people you trust deeply or perhaps a lawyer.

[Siomon]

Group health insurance is the primary insurance for many of us who are 65 and over but still working........and that?s a lot of people!  Workers? compensation insurance is the primary(usually it?s the only) coverage for on-the-job injuries.    This has not been clearly understood by employers, insurance companies, or providers of service.  But that is changing, and both secondary payers(group insurance, when the company has 20 or more employees) and providers(doctors, hospitals, etc.) have been put on notice about the rules.  Larger companies must provide primary insurance for Medicare-eligible employees;  small companies with fewer than 20 employees get a pass, and are secondary payers.  And providers of medical care and services must be sure which insurance is primary.  Rules as to primary and secondary may be found at:    http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf   Make your employer's HR department aware of these provisions, and let them sort it out for you.  But it's in your best interests to be knowledgeable yourself!     Here's the notice:  As Workers Age, Medicare Overlap Kicks in: "Secondary payer provisions are designed to protect Medicare from paying for services that should be covered by self-insured companies, workers? compensation or group health insurers. To put more teeth in the law, payers are now required to submit quarterly electronic reports on claims involving Medicare beneficiaries or face potentially onerous fines of up to $1,000 per claim, per day. Medicare will use the information to recoup an estimated $1.74 billion of inappropriately paid benefits per year. The Centers for Medicare and Medicaid Services(CMS) says ?providers, physicians and other suppliers? must help payers collect and coordinate beneficiary information. The incentive for compliance is prompt reimbursement; the disincentive is the risk of having a claim returned unprocessed, denied or suspended for further investigation. Providers who ?repeatedly provide inaccurate information on the existence of other health insurance coverage? can be fined up to $2,000. CMS advises providers to collect patient health insurance coverage information at each visit. A model questionnaire is available at http://www.cms.hhs.gov/manuals/downloads/msp105c03.pdf          

[Enapay]

When you go on Medicare as I am. Medicare becomes your primary Insurance Company. It is going to pay 80% of your Doctor bills and Hospital bills after you meet your yearly deductible. Your other Insurance Company is now your supplement Insurance that is there to help you pay what Medicare doesn't cover. In you case as you say your secondary Insurance Company is picking up the other 20%. That is 100% coverage on all items that Medicare pays.   You are actually lucky, my supplement 2 years ago went from 20% to 10%. This coverage is provided by my exemplary. You can not have to main Insurance Company's only one. As soon as you signed up for Medicare that became your main Insurance Company, by law you are allowed to have one additional Insurance Company and it can not pay more than the 20% that Medicare doesn't carry.   If you are receiving medical bills and have met your deductible for the year, then tell these providers to resubmit your claims since you are covered 80/20% for a medical coverage. Delvet 47 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.

[Ellmelech]

Medicare becomes your primary Insurance Company. It is going to pay 80% of your Doctor bills and Hospital bills after you meet your yearly deductible. Your other Insurance Company is now your supplement Insurance that is there to help you pay what Medicare doesn't cover. In you case as you say your secondary Insurance Company is picking up the other 20%. That is 100% coverage on all items that Medicare pays.   You are actually lucky, my supplement 2 years ago went from 20% to 10%. This coverage is provided by my exemplary. You can not have to main Insurance Company's only one. As soon as you signed up for Medicare that became your main Insurance Company, by law you are allowed to have one additional Insurance Company and it can not pay more than the 20% that Medicare doesn't carry.   If you are receiving medical bills and have met your deductible for the year, then tell these providers to resubmit your claims since you are covered 80/20% for a medical coverage.

[Deependu]

Your employer's insurance carrier may be in for a surprise soon, as they learn they may be your primary carrier! Group health insurance is the primary insurance for many of us who are 65 and over but still working........and that?s a lot of people!  Workers? compensation insurance is the primary(usually it?s the only) coverage for on-the-job injuries.    This has not been clearly understood by employers, insurance companies, or providers of service.  But that is changing, and both secondary payers(group insurance, when the company has 20 or more employees) and providers(doctors, hospitals, etc.) have been put on notice about the rules.  Larger companies must provide primary insurance for Medicare-eligible employees;  small companies with fewer than 20 employees get a pass, and are secondary payers.  And providers of medical care and services must be sure which insurance is primary.  Rules as to primary and secondary may be found at:    http://www.medicare.gov/Publications/Pubs/pdf/02179.pdf   Make your employer's HR department aware of these provisions, and let them sort it out for you.  But it's in your best interests to be knowledgeable yourself!     Here's the notice:  As Workers Age, Medicare Overlap Kicks in: "Secondary payer provisions are designed to protect Medicare from paying for services that should be covered by self-insured companies, workers? compensation or group health insurers. To put more teeth in the law, payers are now required to submit quarterly electronic reports on claims involving Medicare beneficiaries or face potentially onerous fines of up to $1,000 per claim, per day. Medicare will use the information to recoup an estimated $1.74 billion of inappropriately paid benefits per year. The Centers for Medicare and Medicaid Services(CMS) says ?providers, physicians and other suppliers? must help payers collect and coordinate beneficiary information. The incentive for compliance is prompt reimbursement; the disincentive is the risk of having a claim returned unprocessed, denied or suspended for further investigation. Providers who ?repeatedly provide inaccurate information on the existence of other health insurance coverage? can be fined up to $2,000. CMS advises providers to collect patient health insurance coverage information at each visit. A model questionnaire is available at http://www.cms.hhs.gov/manuals/downloads/msp105c03.pdf           charlie95 47 months ago Please sign in to give a compliment. Please verify your account to give a compliment. Please sign in to send a message. Please verify your account to send a message.