If you recently received a Medical bill you believe you shouldn’t have to pay, here’s what you need to do:
First, let’s determine your out-of-pocket responsibility on your supplemental plan (also known as Medigap policy).
If you are covered by a Plan F: You have no out-of-pocket responsibilities provided the services you receive are medically necessary and Medicare approved. Bottom line - If you receive a bill don’t pay it without further investigation. Skip to the “Resolution” section below.
If you are covered by a Plan G: Your out-of-pocket responsibilities are limited to the Medicare Part B deductible. That deductible amount for 2020 is $198. You are responsible for the first $198 of medical bills. Once you have paid deductible, the plan will pay 100% of all medical services you receive as long as they are medically necessary and Medicare approved.
If you are covered by a Plan N: You have three out-of-pocket responsibilities. First, you will pay a $20 copay at the doctor's office and $50 copay at the emergency room. Second, you are responsible for the Medicare Part B deductible amount of $198. Finally, you are responsible to pay any excess charges charged by your physicians. The excess charge can be up to 15% of the Medicare approved amount. Beyond these three charges, as long as all the medical services you receive are medically necessary and Medicare approved, you are responsible for no bills.
Resolution #1: If you are being charged an amount that is over and above the charges listed above it is likely because someone in the doctor's office made a coding error. Our suggestion is to call the doctor’s office immediately and tell them you believe there is an error and request they double check and re-run the code. 99% of the time this will resolve your billing issue.
Resolution #2: There is a very small chance that your doctor recommended something that was not a medically necessary or Medicare approved procedure. Remember, your supplemental plan pays ONLY after Medicare has paid their portion of the bill. If Medicare doesn’t pay - neither will your supplemental plan. In the event that this happened, you will be responsible to pay the amount billed to you.
Resolution #3: If you are JUST beginning Medicare - and this is your first claim you may be receiving bills due to something known as “Crossover.” This happens when your doctors office, hospital, or pharmacies mistakenly billed your old insurance out of habit. We recommend the very first time you have a service when you begin Medicare to be very proactive to make sure your provider knows they need to DELETE all previous insurance information. If they accidentally continue to bill the old insurance company, Medicare will be pushed to the secondary payor position and Medicare will deny any claims, and in turn your supplemental plan won’t pay either, and you’ll be asked to pay.
The only way to resolve this is for you to call Medicare to resolve the issue. You might have to wait a while, but once you speak to someone, it should be very easy to resolve. Simply call the Medicare Benefits Coordination Recovery Center at 855.798.2627 and explain to the representative that there is a billing problem that is likely related to your records not getting crossed over correctly. You’ll need to verbally authorize Medicare to remove your old insurance as a payor from your account, and replace it with your new insurance details (Medicare & Supplemental Plan Details). Once you have done this you can contact your service provider and have them re-run the billing request.
If you have a question about a Medical Bill question that hasn’t been answered by this article - please contact us.