[rsmurano]

I have never had a surgery/procedure/visit not covered by Medicare. I always ask my dr if it is covered by Medicare and they have always said yes. My supplement G plan always covers the rest of the cost over what Medicare pays for.

Every year, I look at the different plans (advantage vs supplements) and I will never ever get an advantage plan. If you look at ALL advantage plans at the national level, these insurance companies refuse surgeries/procedures/expert referral visits in the millions every year whereas Medicare doesn’t require referrals or pre-surgery clearances. The advantage plans are so bad that Congress is looking into making huge changes to these advantage plans so they can’t deny services. Get any of the supplements while you can because you might not be able to go to a supplement after being on an advantage plan.

[LuLinn]

If Medicare doesn't pay, Medicare supplement does pay. It has been that way for years.

[biker1]

Not exactly. With your Plan G, you may be billed for the annual Part B deductible. It isn’t much, $200+, but you will be billed for it by the provider when you use services covered under Part B. I have Plan N, and have some copays along with the Part B deductible. Plan F, which is no longer available to those starting Medicare, includes the Part B deductible, albeit at an incremental premium cost over Plan G that may be in excess of the Part B deductible.

Originally Posted by rsmurano

I have never had a surgery/procedure/visit not covered by Medicare. I always ask my dr if it is covered by Medicare and they have always said yes. My supplement G plan always covers the rest of the cost over what Medicare pays for.

Every year, I look at the different plans (advantage vs supplements) and I will never ever get an advantage plan. If you look at ALL advantage plans at the national level, these insurance companies refuse surgeries/procedures/expert referral visits in the millions every year whereas Medicare doesn’t require referrals or pre-surgery clearances. The advantage plans are so bad that Congress is looking into making huge changes to these advantage plans so they can’t deny services. Get any of the supplements while you can because you might not be able to go to a supplement after being on an advantage plan.

[biker1]

Depends on the supplemental plan. With some supplemental plans, there are some costs that you will be responsible for.

Originally Posted by LuLinn

If Medicare doesn't pay, Medicare supplement does pay. It has been that way for years.

[JGibson]

Let them sue you in court, you don't even need a lawyer.

Medical bills no longer go on your credit report.

Worst case scenario is they settle for much less than they were asking.

[themailman22]

No Surprises: Understand your rights against surprise medical bills | CMS

[kathietg]

Originally Posted by APovi

MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!

Health care providers are required to have traditional Medicare patients sign an ABN. Google it.
My understanding is that I they did not the patient is not responsible or the bill

[Lynnesail]

Originally Posted by LuLinn

If Medicare doesn't pay, Medicare supplement does pay. It has been that way for years.

Not true, just the opposite.

[JRcorvette]

Originally Posted by APovi

MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!

Most of that is true except the doctor can check with Medicare before a procedure and they should know if something routine is covered or not! Find a new doctor.

[bonrich]

We use Quest Labs for our blood work. The phlebotomist should/could tell you as they are punching in the tests ordered, what is not covered and your responsibility to pay for the test. Then comes the choice to make, refuse it, or do it because it may be needed by your MD. I made a choice a while ago to go ahead and do the test. Quest could not give me an amount for it. My bill for that was $120. Dr's office was surprised by the charge, come to find out, coding error.

[Dkintzer]

I have been a nurse for over 40 years, the last 15 in an office in Jacksonville, AND, I am a medical coder. This is the advice I give EVERYONE.. CALL YOUR INSURANCE COMPANY FIRST! The phone # is on the back of your card. They pay the bill, they know what your particular plan covers. If they say it’s covered & you get a bill, call them back, with bill in hand, & ask if you owe this. Usually you don’t & they will contact the biller. The cause of the problem is most commonly that they used the wrong ICD-10 code to bill with…resubmit with the correct code & like magic…they get paid. I did this for a living & recuperated thousands of $$ for the office I worked for (that they thought they had to write off.) Unfortunately the US government has made this so difficult & such a game, that even the people in a lot of medical offices don’t understand it because they can’t afford to hire the folks with degrees in Health Information Management, like the hospitals can, who know the game & coding in totality. Sad, but a fact of life. Good luck & remember, NEVER pay a medical bill, except your copay, without calling your insurance provider FIRST! (Even the beginning of the year deductible is tracked by your insurance & they can say when you have met it, since the offices don’t have that info.)

[Wondering]

Originally Posted by APovi

MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!

If Medicare doesn't cover a doctor ordered procedure, then I question whether the procedure is legitimate or necessary. In addition, if your supplement doesn't cover the cost, the same rationale applies. So, what was the procedure, and what is the doctor's medical specialty?

[tombpot]

The doctors know what is covered if not they can code it again and submit it to Medicare. Sounds like you have an Advantage Plan

[Justputt]

Originally Posted by APovi

MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!

If you have Government Medicare, the doctors know what's covered and not covered, and they should have informed you. The link someone provided about regarding "Surprise Bills" is the operative issue. They are not allowed. We've had these type bills wiped out before, even with my kids. If you have Medicare Advantage, that is just private insurance with the Medicare name on it, and it has nothing to do with Government Medicare, you have one or the other. In the case of advantage plans, they can be very spotting on what they'll pay us for (I work in oncology). One Advantage plan may pay and the next one won't, even though they're supposed to follow Medicare guidelines. They will usually have things like Local Coverage Determinations (LCDs) for the more expensive procedures. It's not unusual for LCDs to change and not be told until they reject the charge and say, oh there's a new LCD. We always provide an estimated bill, when ask by a patient, although we cannot estimate beyond our own specialty. IMO, go to the Surprise Bill link read it and follow the procedures for your State.

[Marine1974]

Originally Posted by APovi

MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!

Who is responsible for obtaining preauthorization?

healthcare provider
Who is responsible for obtaining prior authorization? The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.