Doctors taking Medicare but not Medigap?

[crs6633]

I had a curious case this week with an older couple in Las Vegas who've been on my books for years. Their doctor retired and he merged or sold his clientele to a physicians group called Southwest Medical who also happens to be owned by OptumCare (UHC's medical services branch). When they went to see their new doctor the front office told them that they would accept Medicare but that they do not accept Cigna supplements as they do not have a contract with them. This created a problem which many of you have encountered already as have I where the clerk at the front desk doesn't know the difference between a Medicare Advantage Plan and a medigap plan. As I attempted to explain the difference I was referred to the business office as apparently all of their billing is done by a third party.

When I spoke with the business office they said the same thing the front desk did; that they do not accept any medicare supplements except United Healthcare since they're owned by United Healthcare. Then they went on to say that they don't like to bill companies that don't pay them. When I pressed them they finally said that they'd be willing to bill the supplement company but that there would be no promises as to whether they supplement company would pay. I was livid and informed them I would be recommending no one use their facilities.

Question 1: Is there legislation regarding supplements used with Medicare and where can I find it?

Question 2: When physician groups bill Medicare and a supplement plan do they bill them individually and simultaneously?
Or, do they send the bill first to Medicare along with the relevant policy number and plan from their Medigap company?

If you're wondering why I'm bothering its because I'm looking to move this couple to a new carrier as Cigna has gotten way too expensive and they're balking due to this whole problem of doctors not taking supplements.

 

[Midlevel]

If they bill Medicare there is no reason to even present a Med Sup card. There is a crossover set up between Medicare and their Med Sup company so after Medicare decides if it’s a covered charge they then forward to the Med Sup so they can pay their portion. Never heard of a Drs. office having control over what a Med Sup pays. Maybe they are just trying to scare people into switching to UH. Sounds to me like they need to be turned into CMS.

 

[goillini52]

I had a curious case this week with an older couple in Las Vegas who've been on my books for years. Their doctor retired and he merged or sold his clientele to a physicians group called Southwest Medical who also happens to be owned by OptumCare (UHC's medical services branch). When they went to see their new doctor the front office told them that they would accept Medicare but that they do not accept Cigna supplements as they do not have a contract with them. This created a problem which many of you have encountered already as have I where the clerk at the front desk doesn't know the difference between a Medicare Advantage Plan and a medigap plan. As I attempted to explain the difference I was referred to the business office as apparently all of their billing is done by a third party.

When I spoke with the business office they said the same thing the front desk did; that they do not accept any medicare supplements except United Healthcare since they're owned by United Healthcare. Then they went on to say that they don't like to bill companies that don't pay them. When I pressed them they finally said that they'd be willing to bill the supplement company but that there would be no promises as to whether they supplement company would pay. I was livid and informed them I would be recommending no one use their facilities.

Question 1: Is there legislation regarding supplements used with Medicare and where can I find it?

Question 2: When physician groups bill Medicare and a supplement plan do they bill them individually and simultaneously?
Or, do they send the bill first to Medicare along with the relevant policy number and plan from their Medigap company?

If you're wondering why I'm bothering its because I'm looking to move this couple to a new carrier as Cigna has gotten way too expensive and they're balking due to this whole problem of doctors not taking supplements.

Sounds like they're confused. They don't bill the Med Supp company. They bill Medicare and Medicare forwards the claim to the Med Supp Carrier. The doctor will get paid whether they know which Med Supp they have.

Since they have to have a new doctor anyway, I'd recommend they get their medical care somewhere else. That's one of the benefits of a Med Supp...no network and you don't have to put up with crap like this.

 

[somarco]

front office told them that they would accept Medicare but that they do not accept Cigna supplements as they do not have a contract with them.

Happens more often than it should with brain dead office staff. They think everything is a supplement . . . including MA.

Having similar issues here where I write a lot of Anthem Medigap plans . . . large local hospital in a dispute with Anthem MA . . . hospital and affiliate docs are telling folks "We don't take Anthem, you need to change to another company if you want to come here".

Even the local news (radio, TV and print) are saying Northside Hospital is refusing patients with Anthem Medicare plans because they are no longer "in network" for Anthem.

One of those stupid things you have to put up with and continue educating your clients.

 

[vic120]

Happens more often than it should with brain dead office staff. They think everything is a supplement . . . including MA.

Having similar issues here where I write a lot of Anthem Medigap plans . . . large local hospital in a dispute with Anthem MA . . . hospital and affiliate docs are telling folks "We don't take Anthem, you need to change to another company if you want to come here".

Even the local news (radio, TV and print) are saying Northside Hospital is refusing patients with Anthem Medicare plans because they are no longer "in network" for Anthem.

One of those stupid things you have to put up with and continue educating your clients.

More times than not its this is what Bob said above

However, I have run into this in FL the villages in fl in fact they had a special deal with UHC MA and that's all they would take

They sent out letters to all the residents they will no longer accept original medicare even and UHC MA plan only this was 5 years ago

I have heard of several other places doing this in other states though I have not run into it personally with my clients

 

[policywunk]

I had a curious case this week with an older couple in Las Vegas who've been on my books for years. Their doctor retired and he merged or sold his clientele to a physicians group called Southwest Medical who also happens to be owned by OptumCare (UHC's medical services branch). When they went to see their new doctor the front office told them that they would accept Medicare but that they do not accept Cigna supplements as they do not have a contract with them. This created a problem which many of you have encountered already as have I where the clerk at the front desk doesn't know the difference between a Medicare Advantage Plan and a medigap plan. As I attempted to explain the difference I was referred to the business office as apparently all of their billing is done by a third party.

When I spoke with the business office they said the same thing the front desk did; that they do not accept any medicare supplements except United Healthcare since they're owned by United Healthcare. Then they went on to say that they don't like to bill companies that don't pay them. When I pressed them they finally said that they'd be willing to bill the supplement company but that there would be no promises as to whether they supplement company would pay. I was livid and informed them I would be recommending no one use their facilities.

Question 1: Is there legislation regarding supplements used with Medicare and where can I find it?

Question 2: When physician groups bill Medicare and a supplement plan do they bill them individually and simultaneously?
Or, do they send the bill first to Medicare along with the relevant policy number and plan from their Medigap company?

If you're wondering why I'm bothering its because I'm looking to move this couple to a new carrier as Cigna has gotten way too expensive and they're balking due to this whole problem of doctors not taking supplements.

Their website says they take the original medicare Accepted Health Plans - Southwest Medical so just tell client to say that is what they have without mentioning an insurance company.You may want to ask for a stupidviser if they still push back.

 

[LostDollar]

Sounds like they're confused. They don't bill the Med Supp company. They bill Medicare and Medicare forwards the claim to the Med Supp Carrier. The doctor will get paid whether they know which Med Supp they have.

Since they have to have a new doctor anyway, I'd recommend they get their medical care somewhere else. That's one of the benefits of a Med Supp...no network and you don't have to put up with crap like this.

I'm making the rounds of an assortment of providers-Docs, Clinics, Hospitals-They are all asking for my Medigap or Supplement card along with my Medicare card. I keep them both together and just give the clerks both of them. Makes everybody happy and I haven't had any checkout problems so far.

 

[Travis Price]

Makes everybody happy and I haven't had any checkout problems so far.

Likely, they want to know if you're covered for gap and how much they need to charge you.

It's not a big deal that they ask. The big deal is when they refuse services because they don't know the difference between Original Medicare and Medicare Advantage.

 

[goillini52]

I'm making the rounds of an assortment of providers-Docs, Clinics, Hospitals-They are all asking for my Medigap or Supplement card along with my Medicare card. I keep them both together and just give the clerks both of them. Makes everybody happy and I haven't had any checkout problems so far.

I have to show my card too. They want to know if you've got a Med Supp. If not, they want a copay.

 

[sshafran]

I have to show my card too. They want to know if you've got a Med Supp. If not, they want a copay.

Which doesn't make sense. How would they know if you paid the deductible or not? And if Medicare hasn't repriced yet, do they just estimate?