Medicare and Auto-crossovers to Supplemental Insurance

[zaqxsw]

I'm posting this from an information standpoint for others.

I have had traditional Medicare plus a UHC Medigap policy for close to two years. No real problems, but thought I would point out the "glitch" possibility with how the two work together through the Medicare "auto-crossover" system. That system has Medicare pay first and then they forward the balance automatically to your Medigap plan to pay. It is pretty slick.

I have had three occasions where this didn't work. The most recent involved a hospital bill. Medicare paid, but I never saw the balance of the claim show up at UHC and the provider was going to bill me. I called UHC and they had never received the claim. I called Medicare and eventually got to a claim specialist who confirmed that the "system" had not forwarded the claim to UHC. It was a "glitch". When I asked if this was rare, she said no, she deals with them every week. They don't really know what causes them. Also, there is nothing they can do about it if it doesn't automatically happen. They offer to snail mail you the EOB which you can then somehow send to UHC with an explanation...

I also had physical therapy two years ago. A dozen claims and none auto-crossed over. Pursuing with Medicare, the code used by the provider prevented auto-crossover from working. I had the PT provider bill UHC separately and they paid. Last year my wife also had PT at the same provider. Same problem which took me intervening numerous times to straighten out. What is really bothering is that neither Medicare nor the PT provider figured out what the code problem was.

It has always been Medicare's suggestion to snail mail me EOB's and have me submit to UHC. Not good and not the way to handle these situations. You need to go back to the providers, explain what happened, and have THEM submit the claims to UHC. They have all of the required Medicare claim info and can do it electronically in just a few minutes.

[momoftwo]

Thanks for the details on this.

I came across this when DH started Medicare a few years ago.
My retiree health plan had been his primary; moved to secondary when Medicare started.

We started getting bills from dr offices for balance after Medicare paid their part.
Called Medicare. They told me that the "autocrossover" hadnt been set up. I asked them to do it .
No, the secondary plan had to do it.
Called secondary. They tell me that Medicare had to do it.

Called Medicare back. They setup a conference call with secondary.
They told secondary they needed to do it. Secondary disagreed.
Medicare stood hheir ground.
Finally secondary agreed to pursue with their administrators.

After a few weeks, secondary rep found correct dept in their company to set up the crosover. Yaaaaay.
All is working smoothly now.

Cant wait till this fall when I sign up for Medicare.

You gave good info for anyone new ti Medicare!

[harllee]

I had this one time --Medicare paid a bill but the bill was not automatically crossed over to my supplement. I call the medical provider and they sent the bill directly to my Medicare supplement showing what Medicare had paid and then the supplement paid.

[braumeister]

Quote:

Originally Posted by zaqxsw When I asked if this was rare, she said no, she deals with them every week. They don't really know what causes them.

That surprises me. Lots of bills over quite a number of years and this has never happened to me. Maybe I've just been lucky?