Medicare and Supplement payments

[target2019]

I was hospitalized late January, and received a bill from the hospital for $1,736.00 on February 25th, due on March 26, 2026.

I see that this amount is the Medicare Part A deductible. I expect that would be paid by my Supplement insurance - UHC plan G.

There is nothing on the insurer's site yet (EoB), though.

Question is, does Medicare normally show any payment made by the insurer?

Maybe I need to open a support ticket, or something like that on the UHC site?

Additional informaation is that Medicare and UHC have paid various physicians, and I assume that is Part B.

 

[ShokWaveRider]

The hospital should bill the Supplement provider simultaneously (Assuming you told them of your coverage) and it will all work out in the wash. You will have to pay the Medicare part B deductible.

 

[target2019]

The hospital should bill the Supplement provider simultaneously (Assuming you told them of your coverage) and it will all work out in the wash. You will have to pay the Medicare part B deductible.

Yes, the hospital took my Medicare and UHC cards at admission.

Part B deductible was met in January.

Thanks for responding.

 

[plsprius]

I'd just wait it out. Don't panic! It should get paid in time without you having to do anything.

If you were really curious, check the claim and associated Medicare Summary Notice (MSN) on Medicare.gov. In my experience, sometimes a hospital (Part A) 'forgets' to file the claim properly, but since they want to get paid they will correct it.

Take home advice--I would not pay that invoice from the hospital.

 

[target2019]

I'd just wait it out. Don't panic! It should get paid in time without you having to do anything.

If you were really curious, check the claim and associated Medicare Summary Notice (MSN) on Medicare.gov. In my experience, sometimes a hospital (Part A) 'forgets' to file the claim properly, but since they want to get paid they will correct it.

Take home advice--I would not pay that invoice from the hospital.

You answered the question, so, thanks.

The hospital did get the Medicare payment. I do look at the eMSN docs. Most of it makes sense.

 

[audreyh1]

I was hospitalized late January, and received a bill from the hospital for $1,736.00 on February 25th, due on March 26, 2026.

I see that this amount is the Medicare Part A deductible. I expect that would be paid by my Supplement insurance - UHC plan G.

There is nothing on the insurer's site yet (EoB), though.

Question is, does Medicare normally show any payment made by the insurer?

Maybe I need to open a support ticket, or something like that on the UHC site?

Additional informaation is that Medicare and UHC have paid various physicians, and I assume that is Part B.

Make sure the hospital has the Medigap info so they can bill your supplement insurance.

 

[PaunchyPirate]

Using this situation as an example, I was under the impression that the hospital isn't responsible for billing the supplement insurance company at all. I thought the way it worked was that the hospital submits the claim to Medicare. Then Medicare processes the claim and pays their part. Then Medicare sends the claim to the supplement insurance company. Then the supplement company processes the claim and pays their part.

Is this not really how it works?

I know medical providers often (always?) ask for your supplement insurance information so they have a record of the secondary insurance provider. But I didn't think they would send a bill to them unless maybe they suspect something is wrong with the payment process.

I'm not on Medicare yet, but I do manage my elderly mother's claims and I've never seen an issue where her supplement didn't pay. But always a few weeks after Medicare pays their part. To the OP, I would not pay anything yet. I also wouldn't worry about late payments to the hospital yet. But stay on top of it.

 

[ShokWaveRider]

Using this situation as an example, I was under the impression that the hospital isn't responsible for billing the supplement insurance company at all. I thought the way it worked was that the hospital submits the claim to Medicare. Then Medicare processes the claim and pays their part. Then Medicare sends the claim to the supplement insurance company. Then the supplement company processes the claim and pays their part.

Is this not really how it works?

I know medical providers often (always?) ask for your supplement insurance information so they have a record of the secondary insurance provider. But I didn't think they would send a bill to them unless maybe they suspect something is wrong with the payment process.

I'm not on Medicare yet, but I do manage my elderly mother's claims and I've never seen an issue where her supplement didn't pay. But always a few weeks after Medicare pays their part.

If your assumption was correct, there would be no point giving your supplement info to any provider. BUT, they always ask for it. I know what my doctor tells me and that is that they bill both Medicare and the supplemental insurance company. It would save providers extra administration if Medicare did it for them.

 

[audreyh1]

Using this situation as an example, I was under the impression that the hospital isn't responsible for billing the supplement insurance company at all. I thought the way it worked was that the hospital submits the claim to Medicare. Then Medicare processes the claim and pays their part. Then Medicare sends the claim to the supplement insurance company. Then the supplement company processes the claim and pays their part.

Is this not really how it works?

I know medical providers often (always?) ask for your supplement insurance information so they have a record of the secondary insurance provider. But I didn't think they would send a bill to them unless maybe they suspect something is wrong with the payment process.

I'm not on Medicare yet, but I do manage my elderly mother's claims and I've never seen an issue where her supplement didn't pay. But always a few weeks after Medicare pays their part. To the OP, I would not pay anything yet. I also wouldn't worry about late payments to the hospital yet. But stay on top of it.

I know of at least one scenario where the supplement wasn’t billed probably because DH didn’t give the hospital that info.

 

[PaunchyPirate]

I guess in reality there are various things that can happen. But there certainly is a concept called "Claims Crossover" where Medicare sends claims data to supplement insurance providers for processing.

Claims Crossover | Medicare Billing: CMS-1450 & 837I

 

[PaunchyPirate]

OP, on my mother's MSN documents, Medicare adds a note on claims that are paid and then sent over to her supplement for additional payments, if any might be due. The note is shown by a single letter code on the charge line item and then that code is explained below the claim details. You might look to see if you have such a note on your MSN.

"This information is being sent to your private insurer. They will review it to see if additional benefits can be paid. Send any questions regarding your supplemental benefits to them. Your private insurer is your supplemental insurer(s)."

 

[target2019]

I imagine that the UHC supplement process could find some problems with the hospital bill.

For example, Medicare and insurer teamed up and paid for a ct scan and X-ray by a 3rd party in the hospital. But I also see those items on the hospital bill.

 

[braumeister]

Using this situation as an example, I was under the impression that the hospital isn't responsible for billing the supplement insurance company at all. I thought the way it worked was that the hospital submits the claim to Medicare. Then Medicare processes the claim and pays their part. Then Medicare sends the claim to the supplement insurance company. Then the supplement company processes the claim and pays their part.

Is this not really how it works?

That is exactly how it has always worked for me.

 

[PaunchyPirate]

I imagine that the UHC supplement process could find some problems with the hospital bill.

For example, Medicare and insurer teamed up and paid for a ct scan and X-ray by a 3rd party in the hospital. But I also see those items on the hospital bill.

If Medicare paid their share of the cost, then UHC should be paying their remainder of the cost. UHC supplemental insurance does not get to determine what a covered procedure. If Medicare covers it (and pays), then UHC has to as well. If Medicare rejected it as a covered procedure, then UHC doesn’t have to pay for it either.

 

[target2019]

If Medicare paid their share of the cost, then UHC should be paying their remainder of the cost. UHC supplemental insurance does not get to determine what a covered procedure. If Medicare covers it (and pays), then UHC has to as well. If Medicare rejected it as a covered procedure, then UHC doesn’t have to pay for it either.

The post you quoted is not about what happens at a general level.

The imaging bill appears in the hospital bill, but was billed by a 3rd party radiology and paid by Medicare and insurer as expected.

I have no details on Medicare payment to hospital, just a general reduction number.

And waiting for UHC to deal with the remainder of hospital bill.

The imaging cost appears to me to be double billed.

It's something that I'll wait for, and deal with it then.

 

[audreyh1]

With imaging I usually see two different claims, the radiologist plus the imaging center.

 

[sengsational]

The process I use is first of all, ignore everything they send until at least one month AFTER you see it on the MSN. And I mean don't even look at it. Just put it in the folder for that day's medical procedures.

If, after a month after the MSN, they're still looking for more money than your deductible, go to the billing web site (usually an Epic based portal), and there is a "write to the billing office" button. Click it and say "You need to make sure you filed everything properly because I have evidence that you didn't" (even though you haven't even looked at it). The only evidence you need is it's more than your deductible. This procedure works well for people with low deductible plans. If you have high deductible, the process is different, and more work.

Wait another month. If they send you another bill for the same thing next month, go back to the billing people and say "I'm exercising my right for you to send me a paper bill with every procedure code and what the Medicare approved amount was for each and what remains to be paid. Full details".

Wait another month. If they send you the details without fixing the bill, then you need to look-up the MSN and check each thing, but I doubt it will come to that.

To address the "why do they want my medicare supplemental card", it's because they want to know if they should bill the patient or wait for payment from the supplemental carrier. That's another trick they pull: even though you give them the supplemental card, they bill you what the supplemental carrier will eventually pay, so they get paid twice. You'd probably be able to get your money back, but you'd also probably have to ask for it back.

 

[sengsational]

I have no details on Medicare payment to hospital, just a general reduction number.

If you go to medicare.gov, you can get the details, down to each CPT code, what the fictional rate, the medicare approved amount, and what medicare paid. The only ones you should care much about are the ones that show medicare approved $0. In those cases, someone is left holding the bag. In those cases someone needs to appeal, or eat the cost. That someone can be the provider or you. But it's only you if you actually paid the bill already.

 

[MBSC]

I imagine that the UHC supplement process could find some problems with the hospital bill.

For example, Medicare and insurer teamed up and paid for a ct scan and X-ray by a 3rd party in the hospital. But I also see those items on the hospital bill.

Radiology has a professional component and technical component (use of equipment) that are billed separately when the radiologist is not an employee of the hospital/imaging center. This prevents the facility from being paid for reading/interpreting and prevents the radiologist from being paid for depreciation and electricity.

It is Medicare's j*b to identify billing issues while processing claims, whether the person has a supplement or not.

 

[Steelpony]

I was hospitalized late January, and received a bill from the hospital for $1,736.00 on February 25th, due on March 26, 2026.

I see that this amount is the Medicare Part A deductible. I expect that would be paid by my Supplement insurance - UHC plan G.

There is nothing on the insurer's site yet (EoB), though.

Question is, does Medicare normally show any payment made by the insurer?

Maybe I need to open a support ticket, or something like that on the UHC site?

Additional informaation is that Medicare and UHC have paid various physicians, and I assume that is Part B.

It sounds like you might belong to AARP. I’d call your Part B provider for advice, the professionals who handle those questions all day.

 

[Koolau]

I'd just wait it out. Don't panic! It should get paid in time without you having to do anything.

If you were really curious, check the claim and associated Medicare Summary Notice (MSN) on Medicare.gov. In my experience, sometimes a hospital (Part A) 'forgets' to file the claim properly, but since they want to get paid they will correct it.

Take home advice--I would not pay that invoice from the hospital.

Yeah, I've seen it take several months before everything is finally washed out and you get a bill for $120 or some such. If they start making "threats" then you might make some calls, but otherwise, just wait it out.