Re: Very Frustrated With Doctor's Offfice Over Ins... - Page 5

Lipstickdiva · ‎03-10-2010

Before you go down to the doctor's office with information in hand, make sure the office is the one that actually handles billing, payments, insurance, etc.

Very few medical offices here do their own billing. Most of them have either farmed this out to another company that does nothing but billing or if they are a very large practice with multiple offices, they have a central billing location that is nowhere near me. So if I ever walked into my doctor's office over a billing dispute, they'd send me on my way.

lucieinthesky · ‎01-14-2013

I am happy to report that I went into the clinic today and spoke with the general business manager concerning this problem. I told her up front that if I didn't get an immediate resolution to the problem, I would be filing a complaint against them with the State Board of Insurance. I was calm, but firm. She was actually quite nice and after hearing the whole story and pulling up my account to confirm that they had received payment from Medicare back in early June on both surgeries, she was EXTREMELY apologetic and thanked me for my patience. She said that they had gone through a system change right after I had my surgeries and there were some gliches in it and it appeared I had been sort of "lost in the shuffle". Hmmm.....not so sure about that, but she really couldn't stop apologizing, so I gave her the benefit of the doubt on that one. She told me she would get with their Chief Financial Officer and have him cut the two checks to me - one for each surgery ( a total of a little over $800.00) and there was still a claim that had not been paid that she herself (not her staff) would be calling Medicare on to see what the problem was with that and would let me know tomorrow. So, there should be one more check coming to me for that. Gosh, I wish I had talked to her 2 months ago when I first began calling about this situation!

Ms X · ‎09-13-2012

@lucieinthesky wrote:
@muttmom wrote:
Why isn't Medicare your primary and your husband's insurance secondary?
That I really don't know. I would suppose it is because I had husband's insurance before becoming eligible for Medicare. Are you telling me Medicare should be my primary?

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@lucieinthesky Before you consider making Medicare your primary insurer, please consider this: Does Medicare cover as many procedures as your private insurer? I don't know the answer to this, but if you would get approval to have more things covered it might be good to have Medicare as your secondary insurer. A doctor I know would qualify for Medicare but gets insurance through a world-renowned hospital instead. He's an attending physician there part time and asked for that arrangement specifically. I don't know the reasons for it, but I suspect it is because the coverage is better than for Medicare. Consider which plan will serve your needs best in terms of procedures approved and copays/deductibles and make your decision accordingly.

If you need more information, discuss it with your doctors and perhaps their billing managers.

Stray · ‎04-20-2013

@lucieinthesky wrote:
@Stray wrote:
It all depends on your status. Our Doctor and when I had foot surgery has the right to demand prepayment, co payment or not accept Medicare at all. Many have the statement in the office waiting room. Since you had cataract surgery, the office should be well versed in Medicare

You can submit your claim to Medicare directly as well.

@that being said. @moonchildes scenerio is correct. If your husband is working and beyond 65 and you are an eligible spouse, Medicare is your secondary insurance and your private insurance primary. At 65 you must sign up for Part A only, which covers hospitalization, only not physician fees. So Medicare will not pay anything.

If if your husband is retired and you are over 65, you must notify Medicare and at that time, you are eligible for Part B which will cover physician fees as well.

Also, when Medicare is your primary and you or your physician file a claim and you have overpaid, Medicare will send you the refund. They are good about it and prompt. My husband was recently very ill and follow up visits to his private MD, who is not fully participating, were paid in full by us. He filed the claim noting reimbursement was to go to us....his last visit 6/24 has been reimbursed already by Medicare and our secondary (COB). Be sure you sign up for streamlining or Coordination of benefits with your private insurer so you can track your claims and better understand them. I would suggest calling your husband's insurer as they will be well versed in your coverage and how it works with Medicare.

You can open an account online at mymedicare.gov and track your claim to see if it was filed and any action. If reimbursement, if you are eligible, was to be returned to you, they will follow up because the office will have been paid twice? Or maybe not at all. I would deal with Medicare, not the doctor's office....believe it or not, I find them efficient.

I think you might be confused about your coverage and the office confused as well because if you are 65, many times office staff think you are covered by Medicare A&B and maybe you aren't which will cause a delay. But, I do my own tracking online with Medicare and my private secondary. Print off all EOBs so you understand it all.
When I first signed up for medicare last year , I opened an account with mymedicare.gov and I have been tracking the claims. That is how I knew that they had been paid to the clinic and that the clinic should have long ago re-imbursed me. And, yes, I do have part A & B.