How to reconcile Medicare, Medi-gap, and Physician's bills

[omni550]

Years ago, I seem to recall someone here mentioning their process for reconciling Medicare and Supplemental (MediGap) payments for a procedure before paying any remaining balance to a doctor's office, clinic, etc.

IIRC, it was possibly a preprinted cover sheet with spaces for provider, dates, and amounts to be filled out and to this was attached all the supporting data, MSNs, EOBs, bills, etc.

As these statements don't always arrive in sequential order, it's easy to accidentally pay out of pocket for some bill received without realizing that it actually might have been paid (or will be paid) by insurance. I don't want to overpay and then spend my time chasing a refund.

So far, I've been lucky to often only need a flu shot annually or something equally simple, so I've not had to deal with a host of MSNs, EOBs and the like. Lately, it seems as though I'm having a bit more interaction with various doctors and clinics and am starting to generate more claims. I'd like to be a bit more organized in handling these but due to my lack of experience, I'm struggling a bit.

So, does anyone have a simple system they use to keep track of all this that you are willing to share?

omni

 

[REWahoo]

Don't be in a hurry to make any medical payments.

I pay no medical bills until after I receive the Explanation of Benefits (EOB) from both Medicare and my Medigap provider. Those two documents will explain how much I may owe the provider after they pay their part.

If the amount billed matches what they say I may owe (it almost always does), then I send payment.

 

[Ian S]

Well, that's why I have a G supplement: once I've paid the minuscule annual deductible, I know I don't owe anything more!

 

[CardsFan]

Don't be in a hurry to make any medical payments.

I pay no medical bills until after I receive the Explanation of Benefits (EOB) from both Medicare and my Medigap provider. Those two documents will explain how much I may owe the provider after they pay their part.

If the amount billed matches what they say I may owe (it almost always does), then I send payment.

Well, that's why I have a G supplement: once I've paid the minuscule annual deductible, I know I don't owe anything more!

This^^^

I have only been on Medicare for a little over a year, but it has been pretty easy. In my experience, you will only get a bill from the service provider after they have received all money from Medicare and Supplement. And then it is only for the deductible amount, or a portion there of ($203? this past year).

Since I have a history of skin cancer, and go to the dermatologist quarterly, I hit the deductible early, and then never get another bill.

 

[CRLLS]

I too wait to see both Medicare and the Medigap/Supplement insurance EOB's and reconcile them before I pay the first penny. It often takes several dr. visits before I rack up enough to cover the MC deductible. Until then I have to watch the bills carefully. I have seen the Medicare covered amounts change after the dr sees the 1st reply Medicare response and then resubmits for the same visit with a different code. So definitely wait for Medicare and the Medigap to match and the dr's office bill shows the credit for both.

 

[athena53]

I too wait to see both Medicare and the Medigap/Supplement insurance EOB's and reconcile them before I pay the first penny.

Me three. DH was going for weekly visits to treat a small leg ulcer and the hospital was sending us bills with the boilerplate that "all applicable insurances have been submitted". They coded visits differently, sometimes bunching a few together and it took me forever to construct a spreadsheet to figure it out and conclude that the supplement had never been billed despite the boilerplate. I copied 30 pages of Medicare EOBs and submitted the claims to the supplement carrier. I also informed the facility that they had NOT billed the supplement carrier. DH always carried both cards around so I'm sure they had the information.

 

[Another Reader]

Plan F = What bills?

I toss all the paperwork in a box. One box for each year. If I ever get a bill from a provider, I will dig through that year's box to reconcile. I have three years of boxes now. Think I will throw out the first year's paperwork (2019) at the beginning of 2022.

 

[zaqxsw]

I also informed the facility that they had NOT billed the supplement carrier.

They shouldn't have to bill the supplemental, Medigap company. That's what Medicare's auto-crossover does. But, I've had two cases where that auto-crossover didn't happen in the 2+ years I've been on Medicare + Medigap. So, you do need to pay attention.

You should never have to submit anything to your Medigap company. If the auto-crossover doesn't work, have the provider bill the Medigap company directly with the Medicare bill info. All providers have the ability to do this electronically.

 

[Katsmeow]

What supplement do you have that you owe anything? I have G and I owe nothing beyond the deductible. I recently had cataract surgery and I was getting a premium lens and I knew upfront the part not covered by Medicare.

The other day I was having some relatively routine bloodwork done -- all of which should be covered. This was at the doctor's office. They asked me to sign a form which said they said the lab was requesting. It said they would bill Medicare and if something wasn't covered, then I would have to pay. I refused to pay it and said I didn't want to have any lab work done that Medicare wouldn't pay. (And, if they made a mistake I wanted it to be on them not me). They then said they would send the lab work to Lab Corp who doesn't require the form which was fine by me.

(There are situations where I might agree to pay for a known test that Medicare wouldn't pay for but I would want to know the specific test and why they felt I needed it).

 

[REWahoo]

What supplement do you have that you owe anything?

Plan N. I can be billed up to $20 for each dr visit. For me, the premiums are $30/mo less than Plan G.

 

[athena53]

They shouldn't have to bill the supplemental, Medigap company. That's what Medicare's auto-crossover does. But, I've had two cases where that auto-crossover didn't happen in the 2+ years I've been on Medicare + Medigap. So, you do need to pay attention.

You should never have to submit anything to your Medigap company. If the auto-crossover doesn't work, have the provider bill the Medigap company directly with the Medicare bill info. All providers have the ability to do this electronically.

Thanks- this happened over 5 years ago so maybe the technology has improved.

 

[omni550]

What supplement do you have that you owe anything?

I'm on Plan N. I've not been charged $20/office visit, nor have I met my deductible*.

As I stated, in years prior, I typically have not had much more than an annual flu shot and a mammogram.

Since August, I've had a slew of office visits and tests. And now I'm getting a flurry of MSNs, EOBs, statements, bills*, etc.

*Perhaps the bills will add up to the deductible. I don't know. That's one reason why I'm trying to reconcile everything.

omni

 

[kyzymurgist]

Many Medicare agents including Boomer Benefits handle any billing problems for you. After more than 45 years of that crap, I refuse to deal with that ever again. Maybe yours also?

 

[Sarah S]

The other day I was having some relatively routine bloodwork done -- all of which should be covered.

Katsmeow Is blood work not subject to the deductible? I am new to medicare as of this summer and was surprised that they paid for some lab work when I hadn’t paid any deductible

 

[pb4uski]

Don't be in a hurry to make any medical payments.

I pay no medical bills until after I receive the Explanation of Benefits (EOB) from both Medicare and my Medigap provider. Those two documents will explain how much I may owe the provider after they pay their part.

If the amount billed matches what they say I may owe (it almost always does), then I send payment.

+1 and I can access that claim info online if I want to but I usually just wait for the EOBs to come in via snail mail.

 

[Katsmeow]

The other day I was having some relatively routine bloodwork done -- all of which should be covered.

Katsmeow Is blood work not subject to the deductible? I am new to medicare as of this summer and was surprised that they paid for some lab work when I hadn’t paid any deductible

Hmm. Well I would have assumed that anything would be subject to the deductible assuming you are on original Medicare. I can think of 3 potential situations where you might not be subject to the deductible (or it would be paid by other coverage):

1. You are also on Medicaid

2. You have some sort of retiree benefits that cover the deductible

3. You have a Medicare Advantage plan that doesn't have a deductible for the work you had done.

In my case, I am way past the deductible for this year. After years of only minor health care needs I had eye surgery 3 times this year (vitrectomy and cataracts).

 

[Sarah S]

Hmm. Well I would have assumed that anything would be subject to the deductible assuming you are on original Medicare. I can think of 3 potential situations where you might not be subject to the deductible (or it would be paid by other coverage):

1. You are also on Medicaid

2. You have some sort of retiree benefits that cover the deductible

3. You have a Medicare Advantage plan that doesn't have a deductible for the work you had done.

In my case, I am way past the deductible for this year. After years of only minor health care needs I had eye surgery 3 times this year (vitrectomy and cataracts).

None of the above. I have original medicare and a blue cross supplement ( Massachusetts so not the plans people in most states have but it is like plan g I think with a part b deductible of 200 and something).

I fully expected a bill for the first set but rationalized it could be deemed prevention. Then I saw my specialist ( the deductible applied but did not use it all up) and she ordered a test that could not possibly be seen as prevention and they paid that too. I am mostly curious. After this year I will probably use up the deductible by seeing my specialist twice