if you have medi-care and a secondary insurance should you be billed any portion of a hospital bill????

Question

an outpatient AMB surgery

Answer 1

Depends on how much the secondary coverage picks up. In most cases you wouldn't owe anything, but in some rare cases you might.

Answer 2

It's entirely possible. You need to check the policy of the secondary - they might pay only a percentage or to a certain point. Call the member services number on the card of your secondary plan to verify what's specific to your plan.

The other reality is - any part of a surgery might not be covered by the secondary plan. The hospital, any labs, any doctors you see while in the hospital all bill separately - and any part of them might not be participating in your plan.

Also make sure your secondary plan was billed in the first place by everyone - not all doctors are set up to bill a secondary, and therefore it's the patient's responsibilty to turn in anything to the secondary plans.

Answer 3

You could be. Under Part B, for professional services (radiologist, for example), if assignment of benefits is not accepted by the provider, he doesn't have to limit his bill to what Medicare allows for his service. Medicare Parts A and B both have annual deductibles. If the deductible has been met, under Part B, Medicare will pay 80% of the allowed amount and your supplemental Medicare coverage would pay the 20% difference (after any applicable deductibles). If there was a disallowed amount and no assignment of benefits, the service provider has the right to bill you for the disallowed amount, so you could well have out-of-pocket expenses.

Answer 4

It is very likely you will still have some financial responsibility. Most secondary insurance will coordinate with medicare, and pay based on the benefit level you purchased on the policy. If it is a group health retiree policy, it is quite common for patients to still receive bills for all, or most of their medicare coinsurance /copays /deductibles until they have paid a larger dollar amount specified, per benefit year. Check with your insurance carrier for a detailed explainition of how your specific benefits coordinate with medicare.

Answer 5

Yes, you will likely be billed a portion of it.

Answer 6

no if you have already met your supplemental deductable.