Med Supp Billing Question

[Winter_123]

What are some of the instances where a client/agent would actually need to contact their med supp provider in regard to a claim? Assuming that they are paid up and understand what plan they have and what it covers and there is no misunderstanding about whether their deductible has been paid.

Suppose they have treatment of some sort, then the provider bills medicare and then medicare tells the med supp carrier to pay their share.

What is the normal process here where maybe the doc has not received payment or some other flap. Is the client expected to help out in contacting the carrier to move them along or is it the providers duty to keep working with the carrier.

I am just trying to get a general feel for some of the real life areas where the agent/client need to actually contact the carrier about claims (again assuming that the client is paid up and there is no misunderstanding about what the plan covers). I am getting so that I am making more and more med supp sales but havent really had to do any of this type of service work yet.

Thanks for any info here.

 

[Todd King]

I got this one, this is easy. Just a few things you need to know. First off, if there is a problem where medicare didn't pay a bill, then 99% of the time the problem lies with the doctor or hospital not coding it right. If medicare pays and the supp company didn't, then there is a loss of communication somewhere between the two. You will sometimes find out that the doctor/hospital did infact get paid but they might have credited it wrong or something like that. You as the agent need to do this. If you can have the client mail you the claim/bill, then you'll have it for your files as a matter of record. If they balk at doing that, which most of the clients don't, then just get the dates of service in question and any other pertinate info you can and call the med supp company and they can tell you all about it. I'm telling you though, 99% of the time the problem lies with the doctor/hospital in these cases. Sometimes you find a doctor trying to double bill...and the bad part is... some of the seniors will just pay the bill without asking questions. You should tell them to never ever pay a bill without justifying it first, unless of course it's part of their yearly deductible. Hope that helps you. If you need more info than this, give me a shout.

 

[Winter_123]

I got this one, this is easy. Just a few things you need to know. First off, if there is a problem where medicare didn't pay a bill, then 99% of the time the problem lies with the doctor or hospital not coding it right. If medicare pays and the supp company didn't, then there is a loss of communication somewhere between the two. You will sometimes find out that the doctor/hospital did infact get paid but they might have credited it wrong or something like that. You as the agent need to do this. If you can have the client mail you the claim/bill, then you'll have it for your files as a matter of record. If they balk at doing that, which most of the clients don't, then just get the dates of service in question and any other pertinate info you can and call the med supp company and they can tell you all about it. I'm telling you though, 99% of the time the problem lies with the doctor/hospital in these cases. Sometimes you find a doctor trying to double bill...and the bad part is... some of the seniors will just pay the bill without asking questions. You should tell them to never ever pay a bill without justifying it first, unless of course it's part of their yearly deductible. Hope that helps you. If you need more info than this, give me a shout.

How does the actual billing flow work there.

Example. Client has work done. Doc bills medicare. What exactly happens next. Does the doc's office just go ahead and bill the med supp carrier. Or they wait for confirmation that medicare paid their share and then bill the balance to the med supp carrier. Or does medicare automatically notify the med supp carrier of their share directly and tell them to pay the doc.

How do the internal mechanics work here exactly?

Thanks.

 

[Russ]

How does the actual billing flow work there.

Example. Client has work done. Doc bills medicare. What exactly happens next. Does the doc's office just go ahead and bill the med supp carrier. Or they wait for confirmation that medicare paid their share and then bill the balance to the med supp carrier. Or does medicare automatically notify the med supp carrier of their share directly and tell them to pay the doc.

How do the internal mechanics work here exactly?

Thanks.

It's automatic claim filing....provider files Medicare...it automaticly crosses over to the med-supp. Sometimes ER claims have to be filed manually from the provider. I haven't filed a med-supp claim in ages. Use to do it frequently.

 

[Todd King]

How does the actual billing flow work there.

Example. Client has work done. Doc bills medicare. What exactly happens next. Does the doc's office just go ahead and bill the med supp carrier. Or they wait for confirmation that medicare paid their share and then bill the balance to the med supp carrier. Or does medicare automatically notify the med supp carrier of their share directly and tell them to pay the doc.

How do the internal mechanics work here exactly?

Thanks.

Here's how it works. It's really simple actually.
The doc bills medicare, sent in electronically, at the same time the doc presents the card of the medicare supp company to medicare who may or may not already have that info. Medicare gets the bill, codes it in and then sends it straight to the med supp company. Rule of thumb to remember with any med supp company...if medicare approves it, then med supp company has to pay their part, period. So it's all done electronically. Sometimes the insurance company actually pays their part before medicare does.

 

[Winter_123]

Here's how it works. It's really simple actually.
The doc bills medicare, sent in electronically, at the same time the doc presents the card of the medicare supp company to medicare who may or may not already have that info. Medicare gets the bill, codes it in and then sends it straight to the med supp company. Rule of thumb to remember with any med supp company...if medicare approves it, then med supp company has to pay their part, period. So it's all done electronically. Sometimes the insurance company actually pays their part before medicare does.

Okay. Thank you.