crs6633
Expert
- 44
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.
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.