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01-04-2019 07:21 PM
@I am still oxox It sounds to me like you would owe $3.00.
Did you get a copy of the Medicare EOB? ( EOMB). It should state what your financial responsibility is.
01-04-2019 07:29 PM
Don't even try to figure it all out - just when you 'think' you understand it all - they change the rules. Suggestion: IF you owe a balance they will bill you - believe me. They know where you live!
01-04-2019 07:42 PM
@fthunt wrote:Don't even try to figure it all out - just when you 'think' you understand it all - they change the rules. Suggestion: IF you owe a balance they will bill you - believe me. They know where you live!
Actually, the rules have not changed. It has always been this way as far back as I can remember...the 1980's and it just as confusing to most people now as it was then.
Some people have primary insurance that pays everything at 100%, So there is no balance for Medicare to consider. I remember telling people to not even offer their Medicare card to the doctor's office to avoid confusion.
Sometimes the more insurance you have, the bigger your problems are.
01-04-2019 08:06 PM
Carmie....?...........I honestly believe no body - nobody - on this board can even entertain a little humor. Laws and rules change or don't change = I could care less. I was just adding a light-hearted post. (forget it! )
01-04-2019 08:06 PM
Thank you I understand this but many people have trouble with this, my problem is I thought once a bill was paid out by the insurance, Medicare pays 80% of the co insurance but this does not seem the case, it seems that they are paying 80% on what they deem reasonable and customary, and not on what I owe to the primary insurer
@Carmie wrote:
@lovesrecess wrote:Just make sure the person at the desk in the drs office knows you have Medicare. They must bill Medicare first; your insurance provider only pays after Medicare has paid their part. Medicare is considered your primary insurance, even if you have private insurance as well.
What you are stating is 100% incorrect. Many people have Medicare insurance that is secondary. You need to read about Medicare secondary payer laws.
01-04-2019 08:47 PM
@Carmie wrote:
@fthunt wrote:Don't even try to figure it all out - just when you 'think' you understand it all - they change the rules. Suggestion: IF you owe a balance they will bill you - believe me. They know where you live!
Actually, the rules have not changed. It has always been this way as far back as I can remember...the 1980's and it just as confusing to most people now as it was then.
Some people have primary insurance that pays everything at 100%, So there is no balance for Medicare to consider. I remember telling people to not even offer their Medicare card to the doctor's office to avoid confusion.
Sometimes the more insurance you have, the bigger your problems are.
I don't mean to belabor a point but there was a time when Medicare was always primary. I had an aunt who never worked, was on Medicare and her husband worked in the coal mines, with the coal miners union exceptional insurance. He was still employed at the time she was having serious medical events. Medicare was primary. I still remember her complaining about it. This was prior to 1980.
Even today, if Medicare won't cover a procedure, test, etc, your private insurance won't either, even if it would prior to you being on Medicare. I ran into this when I still worked but had to sign up for Medicare at age 65, before I retired. HR made this very clear to me & I confirmed with Medicare.
None of this answers the OPs question on co-pays - just saying.
01-04-2019 09:13 PM
@I am still oxox wrote:
Thank you I understand this but many people have trouble with this, my problem is I thought once a bill was paid out by the insurance, Medicare pays 80% of the co insurance but this does not seem the case, it seems that they are paying 80% on what they deem reasonable and customary, and not on what I owe to the primary insurer
@Carmie wrote:
@lovesrecess wrote:Just make sure the person at the desk in the drs office knows you have Medicare. They must bill Medicare first; your insurance provider only pays after Medicare has paid their part. Medicare is considered your primary insurance, even if you have private insurance as well.
What you are stating is 100% incorrect. Many people have Medicare insurance that is secondary. You need to read about Medicare secondary payer laws.
You are correct, Medicare pays 80% of their allowed fee. Your primary insurance probably does the same thing. Most insurance only pays up to a certain amount for each service.
In some states, the doctors must accept the Medicare allowance and can not charge you more than was allowed. In other states doctors can choose to accept the fee or not. In those states, the patient would be responsible for the total amount charged, not the total amount allowed.
It does help you go to a provider who accepts Medicare payment, but sometimes you can't.
I live in PA. That is one of the states where doctors MUST accept Medicare.
01-04-2019 09:16 PM
@fthunt So sorry, I did not mean to step on your toes.
I think you meant to say you couldn't care less, but apparently you do.
My apologies.
01-04-2019 09:49 PM
I think your best option would be: Call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627
I got the number from the Medicare website.
01-04-2019 09:51 PM
@software wrote:
@Carmie wrote:
@fthunt wrote:Don't even try to figure it all out - just when you 'think' you understand it all - they change the rules. Suggestion: IF you owe a balance they will bill you - believe me. They know where you live!
Actually, the rules have not changed. It has always been this way as far back as I can remember...the 1980's and it just as confusing to most people now as it was then.
Some people have primary insurance that pays everything at 100%, So there is no balance for Medicare to consider. I remember telling people to not even offer their Medicare card to the doctor's office to avoid confusion.
Sometimes the more insurance you have, the bigger your problems are.
I don't mean to belabor a point but there was a time when Medicare was always primary. I had an aunt who never worked, was on Medicare and her husband worked in the coal mines, with the coal miners union exceptional insurance. He was still employed at the time she was having serious medical events. Medicare was primary. I still remember her complaining about it. This was prior to 1980.
Even today, if Medicare won't cover a procedure, test, etc, your private insurance won't either, even if it would prior to you being on Medicare. I ran into this when I still worked but had to sign up for Medicare at age 65, before I retired. HR made this very clear to me & I confirmed with Medicare.
None of this answers the OPs question on co-pays - just saying.
I have worked in health insurance for over 25 years...since 1988 actually. Since I worked in Customer Service, I had to go to school to learn the laws for Federal Insurance, Medicare, private insurance and everything else you can think of and things you have no idea exist.
Medicare secondary laws as we know them have been on the books since 1980. Medicare only began in 1966. At that time, Medicare was secondary to workman's comp insurance only.
The MSP laws apply to people who have other insurance sometimes through an employer and it depends on the number of employees that employer has. Also, it depends if the employer Is self insured or not.
Many times and for most people Medicare is primary, but often it is not. The laws apply to the employee and their spouse.
Medicare is also still secondary to workman's comp and auto insurance as well, as in many accident cases, like when you fall in a store.
It is complicated and there is no one size fits all. Every person's circumstances are different.
Medicare wants to save money and will always find a way not to duplicate insurance coverage.
Also, private insurance pays for many things that Medicare does not. It always has. I am very confused by your statement that it doesn't. Private insurance does not have to follow Medicare guidelines for people who do not have Medicare.
If you have Medicare supplemental insurance, either privately or through an employer, it is 100% true that supplemental insurance will not pay if Medicare does not (except for a few services)
I did address the OP's original question.
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