[Sully2023]

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!

Medicare has an app that when used can tell you what is covered or not covered. It’s
medicare.gov

Check it out from the apple App Store and download it.

[DrMack]

You are correct, if I understand Florida office processes as they have been shared. In NH and Massachusetts we delivered medical care and billed Primary and Secondary insurances. Our office receptionist team would check qualifications and the patient would be told what and what wouldn’t be covered.

Circumstances can affect this though. Emergency care vs a scheduled choice options change the whole dynamic. Myself, I often wrote off billing if someone didn’t pay for a treatment because it was on us. It worked out in taxes I was told from our accounting staff. I don’t know of a single doctor that would refuse emergency care to save a life.

[MSGirl]

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!

So many people who are on Medicare plus a supplement believe everything is covered 100% if you have “the best” Medicare plan. That is not true. It is the responsibility of the patient to be sure a procedure,etc is covered. Also, contrary to the belief of these same types of people, not all drs take Medicare. Because you have “the best” Medicare that pays 100%, do your due diligence and be sure Medicare covers it. And before you see a dr, be sure they also take Medicare.

[JMintzer]

Originally Posted by LuLinn

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

Incorrect. Very few Supplemental plans pay if Medicare denies the service...

[JMintzer]

Originally Posted by JRcorvette

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.

Medicare will tell you it's covered, but state that does NOT guarantee payment.

Sooo, once you send in the claim they can (and do) deny the claim...

[JMintzer]

The amount of incorrect information in this thread is staggering...