Medicare Billing Question

[Marita40]

Please excuse a newbie question. I'm brand new to Medicare as of last month. I have a Medicare Supplement plan with BCBS.
I saw my Retinal specialist for my chronic eye condition, which should be covered by insurance. I received a notice from the BCBS Medicare Supplement plan that the service was denied, but a note on the EOB says "According to our records, the patient has Medicare coverage. After Medicare has processed these services, submit the Explanation of Medicare Benefits for consideration of this expense."

How exactly does this work? Will I hear from Medicare that the service was covered by Part B (which I assume it is) in writing, and then need to submit it to BCBS? Or some other process? Thank you!

 

[user5027]

Call the doctor's office and see if they sent the claim to medicare. Sounds like they sent it directly to your supplement (BCBS). Medicare should know you have the supplement and once they review and pay their portion they'll automatically send it along to the supplement. I monitor the claims on the medicare and supplement websites.

 

[MichaelB]

Please excuse a newbie question. I'm brand new to Medicare as of last month. I have a Medicare Supplement plan with BCBS.
I saw my Retinal specialist for my chronic eye condition, which should be covered by insurance. I received a notice from the BCBS Medicare Supplement plan that the service was denied, but a note on the EOB says "According to our records, the patient has Medicare coverage. After Medicare has processed these services, submit the Explanation of Medicare Benefits for consideration of this expense."

How exactly does this work? Will I hear from Medicare that the service was covered by Part B (which I assume it is) in writing, and then need to submit it to BCBS? Or some other process? Thank you!

Yes, Medicare will send you an EOB (explanation of benefits) just like any other insurance. It will stipulate what is covered by Medicare, how much it will pay, how much the MediGap plan pays, and what your share is. You don’t need to submit anything to BCBS.

If you haven’t already done so, you can open an account with Medicare to track these online.

 

[Marita40]

Thank you Michael.

 

[PaunchyPirate]

I'm a few years away from Medicare, but always looking to learn early. Is there a specific step in the process where Medicare is notified exactly who your Medigap supplement company is so that there is this "linkage" of payments between the two?

How does this get set up?

 

[MichaelB]

I'm a few years away from Medicare, but always looking to learn early. Is there a specific step in the process where Medicare is notified exactly who your Medigap supplement company is so that there is this "linkage" of payments between the two?

How does this get set up?

When you receive service from a health care provider you supply both your Medicare number and your MediGap info. When the provider bills Medicare the MediGap info is included. Medicare reviews the charge, determines who pays what, and sends copies to all parties, provider, secondary insurer, and you. It’s a pretty good system for us because the MediGap provider cannot deny or refuse to pay once Medicare has determined it must pay.

 

[PaunchyPirate]

When you receive service from a health care provider you supply both your Medicare number and your MediGap info. When the provider bills Medicare the MediGap info is included. Medicare reviews the charge, determines who pays what, and sends copies to all parties, provider, secondary insurer, and you. It’s a pretty good system for us because the MediGap provider cannot deny or refuse to pay once Medicare has determined it must pay.

OK. So it's not like it's an account setting on your Medicare account. You have to rely on the provider to properly send along the MediGap info to Medicare each time. Interesting. Thanks.

 

[youbet]

^^^^^

I believe on my Medicare account page, it shows what supplement I am signed up with. But, as MichaelB says, I also provide my medical providers with my supplement info. I'll go look at my Medicare account page later when I have time.

 

[MichaelB]

^^^^^

I believe on my Medicare account page, it shows what supplement I am signed up with. But, as MichaelB says, I also provide my medical providers with my supplement info. I'll go look at my Medicare account page later when I have time.

Made me check

My Medicare account also shows both MediGap and Plan D policies.

 

[fh2000]

When you receive service from a health care provider you supply both your Medicare number and your MediGap info. When the provider bills Medicare the MediGap info is included. Medicare reviews the charge, determines who pays what, and sends copies to all parties, provider, secondary insurer, and you. It’s a pretty good system for us because the MediGap provider cannot deny or refuse to pay once Medicare has determined it must pay.

If medicare knows my medigap and Part D policies, why would providers include my medigap policy when billing medicare?

 

[MichaelB]

If medicare knows my medigap and Part D policies, why would providers include my medigap policy when billing medicare?

Because you can change or drop your plan D and MediGap policies?

 

[Go Bolts]

If medicare knows my medigap and Part D policies, why would providers include my medigap policy when billing medicare?

Because the goal of the provider is to get paid. Anything toward that end is a good procedure.

If for some reason there’s an issue with your Medigap, you’ll just get a bill from the provider.

 

[CRLLS]

I have a small question. The posts here say that MC sends you an EOB. In 4 years on MC, neither I nor DW have seen that. we have to go to Medicare website to see the individual EOBs. We do get a quarterly summary mailed to us. Is this normal? Or is there some sort of switch I can flip on the accounts to get EOB's either emailed or paper mailed when MC processes a claim?

 

[MichaelB]

I have a small question. The posts here say that MC sends you an EOB. In 4 years on MC, neither I nor DW have seen that. we have to go to Medicare website to see the individual EOBs. We do get a quarterly summary mailed to us. Is this normal? Or is there some sort of switch I can flip on the accounts to get EOB's either emailed or paper mailed when MC processes a claim?

You’re correct. I get a monthly EOP for Plan D, the MediGap insurer sends an EOB for each claim, but Medicare sends a quarterly statement. I can look at a Medicare individual claim EOB online.

 

[Marita40]

So--for my recent claim, I can view it on the Medicare site rather than them sending me an EOB just for this claim, correct? And I will get a quarterly statement.

That said, I anticipate that my claim is covered by Medicare Part B (haven't checked yet), and that I will owe the annual deductible amount ($203 I think) which I haven't yet paid. Can I assume they will send a bill for that?

 

[user5027]

So--for my recent claim, I can view it on the Medicare site rather than them sending me an EOB just for this claim, correct? And I will get a quarterly statement.

That said, I anticipate that my claim is covered by Medicare Part B (haven't checked yet), and that I will owe the annual deductible amount ($203 I think) which I haven't yet paid. Can I assume they will send a bill for that?

Yes, you will be able to view the claim on the medicare website and they will send you a mailed Medicare Summary Notice (ours are not quarterly).

The Provider will bill you for any deductible. Do not pay until you reconcile with both the medicare claim and supplement's EOB.

 

[Katsmeow]

So--for my recent claim, I can view it on the Medicare site rather than them sending me an EOB just for this claim, correct? And I will get a quarterly statement.

That said, I anticipate that my claim is covered by Medicare Part B (haven't checked yet), and that I will owe the annual deductible amount ($203 I think) which I haven't yet paid. Can I assume they will send a bill for that?

The provider will most likely send you a bill for your deductible once Medicare has paid them. Sometimes it takes a long time before you get that deductible bill. Last year, it took several months for me to get that.

On the other hand, sometimes providers will ask you to prepay the deductible if they have verified coverage with Medicare and they say the deductible hasn't been met. That is fine in most cases. However, one year I saw a doctor and Medicare said I hadn't met my deductible. However, the prior week I had seen another doctor so I knew I had actually met the deductible. In the end, the second doctor refunded me the deductible I prepaid to them once the claim was paid by Medicare and they saw the deductible had been met.

FWIW, for major stuff I usually do check on the Medicare site to see what they have paid. It is usually fairly quick. For example, I just looked and I saw the doctor on 11/2. Medicare received the claim on 11/5 and processed it on 11/9.

If medicare knows my medigap and Part D policies, why would providers include my medigap policy when billing medicare?

You can change your Medicare supplement (medigap) policy any time you want to (and can pass underwriting). Medicare isn't psychic and won't know your supplement has changed unless someone tells them. Providers routinely tell them what you have (providers also don't know what you used to have so don't know if current is "new" or not so they just tell Medicare).

 

[CRLLS]

So--for my recent claim, I can view it on the Medicare site rather than them sending me an EOB just for this claim, correct? And I will get a quarterly statement.

That said, I anticipate that my claim is covered by Medicare Part B (haven't checked yet), and that I will owe the annual deductible amount ($203 I think) which I haven't yet paid. Can I assume they will send a bill for that?

Do you not ask your Dr beforehand it any procedure/test is covered by MC? I do.

It may be different for different supplements but here is how it has worked for me under Plans F-HD and now G. I always wait for a bill from the Dr's office that shows monies they received, or didn't, from both Medicare AND the supplement insurer. I never pay without seeing that on a Dr's office bill. I have had at least one time where the Medicare EOB changed after the Dr's office had re-submitted the claim to Medicare. That changed all the numbers down the line. Once all have done their jobs and agree, only then do I pay the Dr. billing.

 

[TrvlBug]

Wrt to Medicare knowing who the medigap provider is, I believe, just like Part D, the medigap provider advises Medicare. My clinic does not have the info as to who my medigap provider is, yet all my bills are getting fully paid.