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Is Medicare Secondary?
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Re: Is Medicare Secondary?
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SADC
Re: Is Medicare Secondary?
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: 2199
Feb 12 05 9:48 AM
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My Recent Posts
Claude, the answer to your first question pretty much makes #2 and #3 moot.
You will NOT be required to be covered under your wife's policy, plain and simple.
Well, it may not be so simple because depending on the provider's billing system, her insurance may still show up under your claim, so you may have alot of headaches in front of you calling the COB contractor over and over to tell them once again you do NOT have any LGHP coverage.
As far as #4, there may be an open enrollment period every year at which time dependents can be added without proof of insurability. But unless one is in place, you can pretty much bet you will be declined.
If it should happen that you are able to take advantage of an open enrollment period, then we will have to revisit:
#2 You go see your phsysician, who is a contracted provider for your HMO. Their contract allows them receive $90 from the HMO and $10 from you. The provider then bills Medicare, who only pays $60 for the service. Since the $60 is less than the #100, you are not required to pay the copay. However, if the Medicare allowable for that service is, say, $110, then Medicare will pay the remaining $10 copay.
#3 If you choose to see provders who are not contracted with your HMO, you will be responsible for the entire bill. Medicare will NOT pay these charges as primary because there is another party responsible first. The fact that you choose not to utilize those providers is certainly your choice, but you must pay for that choice. There are some exceptions, such as for emergency care when you are away from home.
Either route you go, you may also run into the situation that I commonly see - the the provider assumes that since YOU are retired that your Medicare will always be primary. You may need to educate them to the fact that it's the INSURED'S retirement status that determines primary responsibility, not necessarily the MEDCICARE RECIPIENT'S.
I hope this answers your questions.
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Association News
Medical Billing & Coding Education from the MAB
Continuing Education
Management Advice and Training
Questions Asked More Than Once
Help Wanted - Billing and Coding
Non Billing Talk
The Venting Area (Clean posts please)
Medical Coding and Billing News
Fraud and Abuse
Health Insurance - Provider Contracting
ERISA
Tricare
Workers' Compensation
General Medical Billing Questions
Appeals
Accounts Receivables (A/R)
Refunds
Auto Accident Issues
Medisoft Technical Support
Medical Software Technical Support Questions Other than Medisoft. No Investigation Questions!
General Medical Coding Forum
CPT Coding Questions
HCPCS Coding Questions
ICD-9-CM Coding Questions
Evaluation & Management Coding Questions
Acupuncture Billing and Coding
Ambulance Coding and Billing
Cardiology Coding and Billing
Chiropractic Coding and Billing
Dental Billing and Coding
DME Coding and Billing
Emergency Department Coding and Billing
Family Practice Coding and Billing
Hospital Inpatient and Outpatient Coding
Hospital Billing, Appeals and Collections
Internal Medicine Coding and Billing
Laboratory Coding and Billing
Ophthalmology Coding and Billing
OB-GYN Coding and Billing
Pain Management Coding and Billing
Pediatric Coding and Billing
Podiatry Coding and Billing
Physical Therapy Coding and Billing
Psychiatry Coding and Billing
Radiology Coding and Billing
Surgery Coding and Billing
Neurology Coding and Billing
Urgent Care Coding and Billing
Provider Compliance
Billing Center Compliance
HIPAA
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