Medicare & Supplement

[rfsajohnson]

I just found out that if Medicare does not cover your bill neither will your Supplement which I pay every month. Now I know I'm not well in all of the small print or educated in the medical field, but it's so sad...

[somarco]

@rfsajohnson Medicare is your PRIMARY payer, Medigap is secondary. Your Medigap plan does not adjudicate claims, they only pay what MEDICARE tells them to.

You did not elaborate on what was not paid, nor the reason for the denial.

If your provider properly coded and documented the claim there is no reason for Medicare to deny a MEDICALLY NECESSARY claim.

So far there is no "fine print". This is all spelled out in the Medicare and You Handbook 2022, pgs 75 - 79

https://www.medicare.gov/Pubs/pdf/10050-medicare-and-you.pdf

If your provider billed you for a service that Medicare would not normally cover they should have presented an ABN form BEFORE ordering the test or procedure

https://www.medicare.gov/claims-appeals/your-medicare-rights/advance-beneficiary-notice-of-noncovera...

Absent the ABN form you are not obligated to pay for services your provider SHOULD HAVE KNOWN that may not be covered.

To learn why Medicare denied your medical claim, login to your MyMedicare account and review submitted claims. Any submitted claim that is denied will include an explanation as to why Medicare did not pay the claim.

[rfsajohnson]

Thank you for your response. When I was calling for a different issue my Lab bill, one of the test was not cover. As talking to the agent and brought it up during my other issue.

[GailL1]

SORRY - Just Remember that a Medicare Suppemental plan is better known as a MediGAP - it is just GAP insurance that pays your part of some of the cost - but if Medicare doesn't pay; the GAP pay isn't applicable.

Depending upon what it is that wasn't covered by Medicare, you can appeal it.

https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal 

I did it once - it took me a year of back and forth with all my detailed documentation which I pulled from the Medicare Website on the coverage and why it should be covered; got my Congressman involved too - this was in about 2015.   I had already paid the provider but Low and Behold, I got my money back - Was it worth it - time-wise and headache-wise, only on principal, but I am a stubborn lass  😉.   Proved my point, I guess, or they gave up before me.  But it does give me great satisfaction that there is a new proposed change in the Biden Build Back Better Bill which covers and finalizes this issue so I guess I was not the only one appealing.