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That would be covered under the terms of your policy. In general that is what supplemental, (secondary) insurance is primarily for.
Most "supplemental" plans pay the 20% that Medicare didn't pay only AFTER seeing an "explanation of benefits" statement--i.e. proof that Medicare paid their part. If Medicare denies a service all together, the supplemental plan is often under no obligation to pay at all, as they are there to "supplement" Medicare, not take the place of it in cases of denial. This is especailly true if Medicare denies because the service was deemed "not medically necessary".
So, in short, no. Medicare supplements often do not cover services if they are denied by the primary (Medicare).
Wiki User
∙ 8y ago
Wiki User
∙ 8y agoYes, If medicare pays more than the secondary insurance allows for a charge, the secondary insurance pays nothing. The balance is written off to a contractual allowance that is agreed upon between the provider of service and the insurance company via contract.
Wiki User
∙ 13y agoyes
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Will secondary insurance cover claims denied by your primary insurance?
As long as it is a covered expense by your secondary insurance and a claim has been filed with the primarty insurance then the answer is yes. The secondary insurance will only cover the expense according to your plan.
What type of lawyer should I hire if I have a Medicare claim?
A Medicare attorney is the best choice for general Medicare claims. If you specifically have a claim that has been denied, there are even lawyers who specialize in denied claim cases, frequently referred to as denied claims attorneys.
What do you do if your doctor does not submit to your secondary insurance and now its denied for timely filing?
appeal to secondary insurance
Does blue cross have to pay as secondary if Medicare pays for a procedure as primary?
all depends on the blue cross plan you have. A lot I come by through my job as an insurance biller the secondary will pick up any copays that medicare wouldn't cover. But there is some plans that won't pay if medicare doesn't pay. So, really, yea, your secondary should pick up some cost. Unless it is just co-pays, they have the choice to make that your responsibility as a member. Do take the time to figure it out, a lot of times if you don't fight your own claims, you pay much more than you need to. Always keep and look at your explanation of benefits that you should receive from the insurances after each visit explaining what they paid and what they denied and what you owe. Anything that is not listed in the "Allowable Amount" column, you are not responsible for. Especially if the place you attended is participating with that insurance. A lot of companies try to collect for money that was denied by the insurance, but they(the insurance) states you are not responsible for.
IF Patient primary insurance denied claim because provider is not contracted with them will secondary insurance pay on the claim?
yes
What explains Medicare payments and denials?
The EOB (Explanation of Benefits) is what explains Medicare's payments and denials. Sometimes it is referred to as an EOP (Explanation of Payment). This document will show all items filed on a particular claim for a particular provider. It will show which items were covered or noncovered and why, which items were denied and why, and which items were paid. It will also show the patient's responsibility as far as deductible and coinsurance goes. If the patient has a Medicare supplement or just a secondary plan and Medicare is aware who you have chosen, they will "crossover" the claim to the secondary. This means they will automatically send a notification to the secondary payor to let them know how much Medicare allowed (the total amount the provider should receive from Medicare, other insurance companies and the patient), and how much is being left to the patient/secondary.
What term explains Medicare payments and denials?
The EOB (Explanation of Benefits) is what explains Medicare's payments and denials. Sometimes it is referred to as an EOP (Explanation of Payment). This document will show all items filed on a particular claim for a particular provider. It will show which items were covered or noncovered and why, which items were denied and why, and which items were paid. It will also show the patient's responsibility as far as deductible and coinsurance goes. If the patient has a Medicare supplement or just a secondary plan and Medicare is aware who you have chosen, they will "crossover" the claim to the secondary. This means they will automatically send a notification to the secondary payor to let them know how much Medicare allowed (the total amount the provider should receive from Medicare, other insurance companies and the patient), and how much is being left to the patient/secondary.
What are the downside risks to discount car insurance?
Some people opt for discount car insurance and they get discount insurance coverage, claims can take a while to process and sometimes denied more frequently
With Primary and Secondary Insurance your primary denied your claim because it was over a year is your secondary obligated to pay?
Yes, subject to the limits in their policy. No. With most insurance policies, there is what is called a timely filing limitation. For my company; contracted providers have 6 months, and non-contracted providers have 12 months to submit the claim. If your primary insurance received the claim within timely filing, you may have the option of submitting the claim to your secondary with proof that it was filed in a timely manner. If that doesn't work you can always appeal the decision with the secondary or for that matter the primary insurance company. Policy holders are not responsible for claims that deny for timely filing.
Can you be denied Medicare coverage for any reason if you are a US citizen?
Yes, you can be denied Medicare coverage even if you are a citizen of the United States. Having an income higher than Medicare's current guidelines can disqualify you. There are many other reasons which are all described on the government's Medicare website at medicare.gov.
Filing claim pre existing conditions for appeal?
Many insurance companies will denial claims for pre-existing conditions. You have a right to appeal all claims. You should call your company first to see why the clam was denied.
What is the time limit on refiling a denied Medicare charge?
30 days
