If you recently received a Medicare summary notice stating that Medicare will not pay your bill. The provider told you that Medicare thinks you have other insurance. What should you do? Do you have to pay this bill?
This could be one of the two common reasons. First reason: you have Medicare and Medicare thinks you have another kind of plan ahead. Second is why you have Medicare and are enrolled in the Medicare Advantage plan. If you have Medicare A and B and have enrolled in a Medicare Advantage plan.
In this situation, you already have Medicare A and B, and you have subscribed to a Medicare Advantage Plan facing Medicare A and B. Medicare will not pay for any of the services and paperwork because the Medicare Advantage Plan is financially responsible. for these claims. Many people who enroll in Medicare Advantage plans do not understand this relationship. You must have Medicare A and B, so you pay your Part B premium ($ 170.10 a month for most), but Medicare does not pay your medical bills. By signing the Medicare Advantage (MA) enrollment agreement / agreement, you agree that the MA plan will pay for your health care needs. This agreement requires different procedures to pay for claims. The different procedure may include referrals for specialists, prior approval for treatments and tests, or regional restrictions on your health care. This is different from Medicare. Original Medicare Parts A and B work in any part of the country without permission or necessary references. Medicare Advantage plans sometimes restrict access to health care providers or require prior approval before procedures can occur.
In this situation, enrollees show their Medicare card and Medicare Advantage Plan card. The bill may go to Medicare in error and Medicare will deny the claim (bill) because the MA Plan is responsible for processing the claim. If the medical provider submits the claim to the correct MA Plan, the claim will be processed according to its procedures and, ideally, will be paid. You may have a co-payment for the procedure, but the insurance company will help you pay the cost of the procedure.
If this is your situation, correcting the problem may simply require you to call your provider and talk to the billing department, to clarify that the MA Plan should be billed first and only. Medicare will not pay the claim in this situation. This could be called a benefit coordination issue, but you do not need to involve the Medicare benefit coordination department. It can usually be clarified with a quick phone call to your provider.
MA plans have many different types and advantages. Types are health care organizations (HMOs), preferred provider organizations (PPOs), or private service fee (PFFS). Each of these plans is a Medicare replacement. You must have Medicare A&B to enroll in plans, but once you enroll in an MA Plan, Original Medicare A&B will not cover your medical expenses.
If you’re not sure what your insurance is, take a look at your cards, you may see some of these abbreviations on the front of the card. If not, call the customer service number on the back of the card to ask what your coverage is or how it works. You can also call 1-800-Medicare and ask what Medicare thinks you are enrolled in and this can also help. The www.medicare.gov website is also a tool you can use, although it won’t help you keep track of claims and bills, as Medicare won’t have these records. Your Medicare Advantage plan will have these records. The website www.medicare.gov will indicate which insurance you think Medicare is your primary insurance.
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