Part G Medicare supplement

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effillus
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Part G Medicare supplement

Post by effillus »

If a medical care provider accepts Medicare patients, and the patient has a Part G supplement policy, does the provider HAVE to take the patient's Part G insurance?
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David Jay
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Re: Part G Medicare supplement

Post by David Jay »

What precisely do you mean by: "take"?

I have never heard of a medical provider who refused to accept a check from an insurance company.

In some states physicians are allowed to bill "excess charges" which are above what Medicare approves, in which case a Part G supplement will only pay what Medicare approves. Excess charges are set state-by-state, with a 15% federal maximum. More discussion here: viewtopic.php?t=149533
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22twain
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Re: Part G Medicare supplement

Post by 22twain »

<nit-pick> Plan G, not Part G. </nit-pick>
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diy60
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Re: Part G Medicare supplement

Post by diy60 »

effillus wrote: Wed Sep 22, 2021 1:43 pm If a medical care provider accepts Medicare patients, and the patient has a Part G supplement policy, does the provider HAVE to take the patient's Part G insurance?
Your question isn't clear to me. The connection between Medicare and any Medigap supplemental plan happens behind the scenes. The medical provider should only submit billing to Medicare, and from there it gets coordinated with any supplemental plan. This is why whenever a medical provider asks me if I have any insurance in addition to Medicare I always reply "no". Submitting duplicate claims directly to the supplemental plan will potentially cause billing and payment errors.
Silk McCue
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Re: Part G Medicare supplement

Post by Silk McCue »

effillus wrote: Wed Sep 22, 2021 1:43 pm If a medical care provider accepts Medicare patients, and the patient has a Part G supplement policy, does the provider HAVE to take the patient's Part G insurance?
I’ll go out on a strong limb and say “Yes”. They don’t care what plan you are on. Even if they did they can’t refuse to treat you based on the Medicare plan you have chosen.

What is the specific reason/concern you are asking this question?

Cheers
cashmoney
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Re: Part G Medicare supplement

Post by cashmoney »

diy60 wrote: Wed Sep 22, 2021 4:56 pm
effillus wrote: Wed Sep 22, 2021 1:43 pm If a medical care provider accepts Medicare patients, and the patient has a Part G supplement policy, does the provider HAVE to take the patient's Part G insurance?
Your question isn't clear to me. The connection between Medicare and any Medigap supplemental plan happens behind the scenes. The medical provider should only submit billing to Medicare, and from there it gets coordinated with any supplemental plan. This is why whenever a medical provider asks me if I have any insurance in addition to Medicare I always reply "no". Submitting duplicate claims directly to the supplemental plan will potentially cause billing and payment errors.


Disclaimer licensed agent.That is a smart thing to do although sometimes before scheduling high ticket procedures the rocket surgeon at mayo clinic may want to know how you are going to pay the the 20%. plus excess.I have seen many times poorly trained pcp office staff tell a patient with lets say an AARP UHC medicare supplement that we don't take UHC .The office staff will confuse a UHC medicare advantage plan which they may not participate in with UHC medicare supplement and will some time even refuse to schedule appointment.The stories i could tell you about battling with ding dong office staff you wouldn't believe.So yes just tell the provider you have medicare when asked about insurance.
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celia
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Re: Part G Medicare supplement

Post by celia »

My doctors don’t care who pays them the balance owed on my bills. My neighbor or my dog could pay them and that would be fine.

And I am on Plan G, if that matters.
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FrugalInvestor
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Re: Part G Medicare supplement

Post by FrugalInvestor »

I am also on Plan G. It pays the 20% that Medicare doesn't pay. It also pays the extra that providers can charge if they don't accept assignment (except for 2% sometimes - too complicated to explain here and I don't know if I could anyway). I ended up having a very expensive medical situation, although I had always been very healthy up to that point (and am again now), and was very, very thankful that I had decided on plan G.
Have a plan, stay the course and simplify. Then ignore the noise!
cashmoney
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Re: Part G Medicare supplement

Post by cashmoney »

FrugalInvestor wrote: Wed Sep 22, 2021 7:11 pm I am also on Plan G. It pays the 20% that Medicare doesn't pay. It also pays the extra that providers can charge if they don't accept assignment (except for 2% sometimes - too complicated to explain here and I don't know if I could anyway). I ended up having a very expensive medical situation, although I had always been very healthy up to that point (and am again now), and was very, very thankful that I had decided on plan G.

The reason for the 2% is that after the Balanced Budget Act of 1997 was passed to slow the rate of growth in payments to hospitals, physicians, and other providers medicare basically will only pay 78% to providers who do not accept assignment.Since medicare supplement only pays if medicare pays on it first that 2% is your responsibility.

https://innovation.cms.gov/files/migrat ... a_1997.pdf
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celia
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Re: Part G Medicare supplement

Post by celia »

diy60 wrote: Wed Sep 22, 2021 4:56 pm …This is why whenever a medical provider asks me if I have any insurance in addition to Medicare I always reply "no". Submitting duplicate claims directly to the supplemental plan will potentially cause billing and payment errors.
This is risky, IMO. We show all our doctors our Medicare card and the Supplemental Plan card at each visit and sometimes the supplemental STILL doesn’t get billed. I know it is supposed to be seamless but I get the feeling if the doctor’s office doesn’t bill Medicare with the acknowledgement to then forward the remainder to the supplemental, it won’t go there. I know we have two doctor groups who don’t know how to bill properly and we even tell them up front who will pay second. If we call supplemental to ask what’s holding up the payment, they say no-one’s notified them yet. And we supposedly have 2 places who should have taken care of this (Medicare and the dr office).

This is one of our pet peeves since it is a waste of time for everyone involved.

We even had one case where we had to go to urgent care while out of state. We were unaware of the reputation of this place until we got home. (Medical care was fine but billing was usually screwed up.). They insisted on a credit card as backup when we checked in and were too lazy to bill Medicare. So they just charged us. When we saw it on the credit card bill, we immediately told the credit card company not to pay it, but they paid it anyway. We were so mad at each place who made the problem worse. We canceled the credit card after leaving messages for the billing supervisor who never called us back.

The sad thing was that this wasted a whole day of our vacation. (We had problems just finding the place; that’s another story.) When we got back to our AirBnB place, we met the host who was a nurse and said to never go to that urgent care. She knew of good ones nearby.
:oops:
Big Dog
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Re: Part G Medicare supplement

Post by Big Dog »

cashmoney wrote: Wed Sep 22, 2021 6:17 pm
diy60 wrote: Wed Sep 22, 2021 4:56 pm
effillus wrote: Wed Sep 22, 2021 1:43 pm If a medical care provider accepts Medicare patients, and the patient has a Part G supplement policy, does the provider HAVE to take the patient's Part G insurance?
Your question isn't clear to me. The connection between Medicare and any Medigap supplemental plan happens behind the scenes. The medical provider should only submit billing to Medicare, and from there it gets coordinated with any supplemental plan. This is why whenever a medical provider asks me if I have any insurance in addition to Medicare I always reply "no". Submitting duplicate claims directly to the supplemental plan will potentially cause billing and payment errors.


Disclaimer licensed agent.That is a smart thing to do although sometimes before scheduling high ticket procedures the rocket surgeon at mayo clinic may want to know how you are going to pay the the 20%. plus excess.I have seen many times poorly trained pcp office staff tell a patient with lets say an AARP UHC medicare supplement that we don't take UHC .The office staff will confuse a UHC medicare advantage plan which they may not participate in with UHC medicare supplement and will some time even refuse to schedule appointment.The stories i could tell you about battling with ding dong office staff you wouldn't believe.So yes just tell the provider you have medicare when asked about insurance.
Disagree that its all that smart. Yes, Medicare will send teh balance bill (electronically?) to the Supplement, but that's common knowledge in the billing office. Even if they submit a bill to Medicare adn a separate one to the Supplement, the Supplement won't do squat until they find out what Medicare paid as the Supplement is secondary. Beyond that, as cashmoney notes, if you are in for a procedure, they can confirm coverage up front, and you won't have to pay at the door as the provider will wait until they get paid by Medicare and the Supplement.

IMO, there is no reason not to give your medical providers your Medicare number adn your Supplement plan info. Only been on Medicare for three years and so far, claims have been paid like clockwork. (should I knock on wood?)
cashmoney
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Re: Part G Medicare supplement

Post by cashmoney »

celia wrote: Wed Sep 22, 2021 7:44 pm
diy60 wrote: Wed Sep 22, 2021 4:56 pm …This is why whenever a medical provider asks me if I have any insurance in addition to Medicare I always reply "no". Submitting duplicate claims directly to the supplemental plan will potentially cause billing and payment errors.
This is risky, IMO. We show all our doctors our Medicare card and the Supplemental Plan card at each visit and sometimes the supplemental STILL doesn’t get billed. I know it is supposed to be seamless but I get the feeling if the doctor’s office doesn’t bill Medicare with the acknowledgement to then forward the remainder to the supplemental, it won’t go there. I know we have two doctor groups who don’t know how to bill properly and we even tell them up front who will pay second. If we call supplemental to ask what’s holding up the payment, they say no-one’s notified them yet. And we supposedly have 2 places who should have taken care of this (Medicare and the dr office).

This is one of our pet peeves since it is a waste of time for everyone involved.

We even had one case where we had to go to urgent care while out of state. We were unaware of the reputation of this place until we got home. (Medical care was fine but billing was usually screwed up.). They insisted on a credit card as backup when we checked in and were too lazy to bill Medicare. So they just charged us. When we saw it on the credit card bill, we immediately told the credit card company not to pay it, but they paid it anyway. We were so mad at each place who made the problem worse. We canceled the credit card after leaving messages for the billing supervisor who never called us back.

The sad thing was that this wasted a whole day of our vacation. (We had problems just finding the place; that’s another story.) When we got back to our AirBnB place, we met the host who was a nurse and said to never go to that urgent care. She knew of good ones nearby.
:oops:

Once medicare gets claim from provider it is electronically " crossed over" to the medicare supplement on file ( this is updated to medicare by insurance co.)and insurance carrier pays provider the balance- unless it is a provider who doesn't accept assignment.If provider doesn't accept assignment then after provider files claim you get a check for 78% of part B charges from medicare and another check from insurance carrier for the 20% plus excess charges The provider doesn't file claims to the insurance carrier either way.
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celia
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Re: Part G Medicare supplement

Post by celia »

cashmoney wrote: Wed Sep 22, 2021 8:14 pm
celia wrote: Wed Sep 22, 2021 7:44 pm
diy60 wrote: Wed Sep 22, 2021 4:56 pm …This is why whenever a medical provider asks me if I have any insurance in addition to Medicare I always reply "no". Submitting duplicate claims directly to the supplemental plan will potentially cause billing and payment errors.
This is risky, IMO. We show all our doctors our Medicare card and the Supplemental Plan card at each visit and sometimes the supplemental STILL doesn’t get billed. I know it is supposed to be seamless but I get the feeling if the doctor’s office doesn’t bill Medicare with the acknowledgement to then forward the remainder to the supplemental, it won’t go there. I know we have two doctor groups who don’t know how to bill properly and we even tell them up front who will pay second. If we call supplemental to ask what’s holding up the payment, they say no-one’s notified them yet. And we supposedly have 2 places who should have taken care of this (Medicare and the dr office).

This is one of our pet peeves since it is a waste of time for everyone involved.

We even had one case where we had to go to urgent care while out of state. We were unaware of the reputation of this place until we got home. (Medical care was fine but billing was usually screwed up.). They insisted on a credit card as backup when we checked in and were too lazy to bill Medicare. So they just charged us. When we saw it on the credit card bill, we immediately told the credit card company not to pay it, but they paid it anyway. We were so mad at each place who made the problem worse. We canceled the credit card after leaving messages for the billing supervisor who never called us back.

The sad thing was that this wasted a whole day of our vacation. (We had problems just finding the place; that’s another story.) When we got back to our AirBnB place, we met the host who was a nurse and said to never go to that urgent care. She knew of good ones nearby.
:oops:

Once medicare gets claim from provider it is electronically " crossed over" to the medicare supplement on file ( this is updated to medicare by insurance co.)and insurance carrier pays provider the balance- unless it is a provider who doesn't accept assignment.If provider doesn't accept assignment then after provider files claim you get a check for 78% of part B charges from medicare and another check from insurance carrier for the 20% plus excess charges The provider doesn't file claims to the insurance carrier either way.
Cashmoney, if that was true, why do you think some of our bills aren’t automatically paid, as I already explained? I would love to fix this if I knew what to do.
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