Public Retiree Health Benefits

[Emeritus]

I doubt that I understand the question. Insurance won't pay all possible medical bills -- right? If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it. If I have to pay, I suppose you might say my supplement was not totally suitable -- is that what you're getting at?

the law is very clear
Balance billing of medicare patients by participating physicians is unlawful
Ill put it in again

"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services or supplies provided to a Medicare beneficiary, except when Medicare is the secondary insurer. When Medicare is the secondary insurer, the health care practitioner may pursue full reimbursement under the terms and conditions of the primary insurer, but the Medicare beneficiary cannot be balance billed above the Medicare reimbursement rate for a Medicare-covered service or supply. "Balance billing" does not include charging or collecting deductibles or co-insurance required by the program.

Medicare Balance Billing Main Page

So Participating physicians can only collect the deductible or coinsurance required by the program, which is normally paid by the supplement.
Medicare isn't like private insurance. Its a statutory program enforced by the criminal law. If they take money form medicare and balance bill you it may be a crime
42 U.S.C. § 1320s-7b(e), Illegal Medicare Balance Billing,

Nonparticipating physicians are not covered by this section but have other limits

 

[kyounge1956]

One other thought, though -- just because someone selected " Retirees receive neither paid health coverage nor preferred rates " - it doesn't mean they *necessarily* get nothing. They may also have the option to stay in the group plan if they pay the premiums -- something only rarely offered to private sector retirees. For someone with significant health problems or preexisting conditions that can be extremely valuable even if the group coverage isn't subsidized.

isnt that option 3?

Yes, that's option 3.

 

[GregLee]

"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services ...

So my supplemental insurance or I would only be responsible for paying for a service not covered by Medicare. Is that that what you're saying? Okay. So? I said, previously, that what bills are not covered by Medicare or my supplemental insurance, I must pay. Was that inaccurate? Perhaps you thought I was implying that a bill for a specific service would be partially paid through Medicare and partially by me. But I didn't say or imply that.

 

[Emeritus]

So my supplemental insurance or I would only be responsible for paying for a service not covered by Medicare. Is that that what you're saying? Okay. So? I said, previously, that what bills are not covered by Medicare or my supplemental insurance, I must pay. Was that inaccurate? Perhaps you thought I was implying that a bill for a specific service would be partially paid through Medicare and partially by me. But I didn't say or imply that.

What you wrote was "Medicare is my primary insurer. ...... The doctor/hospital/pharmacy get whatever they can from Medicare, then get whatever else they can from HMSA (my supplemental insurer), then whatever of the bill is left over, I pay." You also wrote
"If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it."

YMMV but that certainly sounds like "a bill for a specific service would be partially paid through Medicare and partially by me"

 

[GregLee]

You also wrote
"If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it."

YMMV but that certainly sounds like "a bill for a specific service would be partially paid through Medicare and partially by me"

The bills I get are usually for a whole list of services.

 

[Emeritus]

The bills I get are usually for a whole list of services.

Each service has to be billed either to medicare or not. The provider is either a medicare provider or not. If they are and the procedure is a medicare procedure they have no choice