Doctors taking Medicare but not Medigap?
- Thread starter crs6633
- Start date
But but, how will they know who to bill for your deductible and copay if you don't show them your Medigap card?
They have my home address, email and phone.
- 4,707
Pure BS! In 99 out of 100 cases, the Med Supp pymt will arrive at the Dr office before the Medicare pymt.
- 6,480
- 4,707
Because you have HDF,My Plan F never pays anything!
sunny1ib
Expert
- 57
Oh my word! This happened a lot to me when I resided in Florida. The Villages have their own happy "marriage" with UHC and they actually have their own Advantage plans. As someone mentioned previously, they sent out a mailer to everyone in the Ocala, plus to everyone in The Villages (32159, 32162, 32163) which basically stated that NONE of the medical offices within The Villages were taking ANY Medigap plans. {EYEROLL PLEASE}. A good friend of mine actually worked at UHC in Product Development at the time, and she was "in" on that development. I will not mention the verbiage exchange on that particular call, as it put someone on the defensive and it wasn't me - but I did get someone to agree that the medical offices/clinics could NOT REFUSE to take Original Medicare (FFS). For my clients that lived in Ocala, New Port Richey and a few other areas in that area, I did relay that don't let some medical staff tell them they don't take nothing but an Advantage plan. It is erroneous information and they can certainly state as such. Of course, they asked if they could redirect the call to me, and who am I to back down and NOT "educate" an office accordingly. 
I had a couple of specialist offices in Sarasota that decided they had to take 20% on any procedures needing to be done - had to talk a few clients off the "high rise" condo downtown, but once a conversation was had with the practice administrator - didn't hear another peep about it again.
Nine times out of 10, all Original Medicare claims are adjudicated with what is called a
"crosswalk". For those who are not aware what that is, whenever your client purchases a Medigap plan (regardless of Plan), the provider's billing office electronically submits a claim to the Medicare (contractor). Medicare then processes said claim based on the codes provided on the electronic billing and its deductible and cost share under Part A and/or Part B. Then, the claim is packed and sent - or crossed over to the appropriate Medigap carrier. The Medigap carrier will then pay in accordance to the data provided by Medicare (contractor). So if your client has Plan F, the Medigap carrier will pay the deductible and all the appropriate cost shares that are approved by Medicare. If it is Plan G or N (or whatever plan purchased), deductible is applied first - EOBs from both Medicare and Medigap carrier will reflect accordingly, deductible countdown begins/or is met, appropriate cost shares will appear.
And that's how it is supposed to work.
If it doesn't, it usually means that the provider billed the wrong carrier (sometimes they still have the employer information or individual information in their system, previous supplement or Advantage plan), could be a coding problem (Medicare is all about codes), and/or sometimes the client asked for a physical instead of his/her Welcome to Medicare Visit. Big difference. Huge! By the tune of $0 to around $800 out of pocket...Ouch!
I had a couple of specialist offices in Sarasota that decided they had to take 20% on any procedures needing to be done - had to talk a few clients off the "high rise" condo downtown, but once a conversation was had with the practice administrator - didn't hear another peep about it again.Nine times out of 10, all Original Medicare claims are adjudicated with what is called a
"crosswalk". For those who are not aware what that is, whenever your client purchases a Medigap plan (regardless of Plan), the provider's billing office electronically submits a claim to the Medicare (contractor). Medicare then processes said claim based on the codes provided on the electronic billing and its deductible and cost share under Part A and/or Part B. Then, the claim is packed and sent - or crossed over to the appropriate Medigap carrier. The Medigap carrier will then pay in accordance to the data provided by Medicare (contractor). So if your client has Plan F, the Medigap carrier will pay the deductible and all the appropriate cost shares that are approved by Medicare. If it is Plan G or N (or whatever plan purchased), deductible is applied first - EOBs from both Medicare and Medigap carrier will reflect accordingly, deductible countdown begins/or is met, appropriate cost shares will appear.
And that's how it is supposed to work.
If it doesn't, it usually means that the provider billed the wrong carrier (sometimes they still have the employer information or individual information in their system, previous supplement or Advantage plan), could be a coding problem (Medicare is all about codes), and/or sometimes the client asked for a physical instead of his/her Welcome to Medicare Visit. Big difference. Huge! By the tune of $0 to around $800 out of pocket...Ouch!
This may not be entirely correct.
I have a client (originally from Georgia) that was able to SEP into a Medigap plan on a GI basis when her MA plain left the market. She moved to FL/Villages about 4 years ago and has kept her plan. Even told me a few times how GLAD she is to have this coverage (cancer survivor) and would never have another MA plan.
Aha! Thanks for the update.
Its not that none take Medicare, but most of the good ones there don’t. They only take uhc MAPD.
- 6,480
Caveat, not an agent
and I don't know what is "right" in this discussion
But I think the thrust of sunny1ib's post is that the providers can't limit themselves to MAPD and refuse to take original Medicare patients.
Similar threads
