Author Topic: Medicare Replacement Plans - Fee For Service  (Read 1414 times)

MNelson

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Medicare Replacement Plans - Fee For Service
« on: February 23, 2010, 04:04:04 PM »
Its bad enough that Medicare is so difficult to deal with then comes along these Medicare Replacement plans. 

I have found that most of these plans have a clause per say that say once you have serviced the patient you are automatically bound to accept what they pay as payment in full even if you are not a par-provider.

Has anyone else had this issue? Does anyone have a laymens breakdown of how thse plans work?   They are giving me quite a run!  They seem to have so many different rules and regulations and they all seem to be a bit different.  Another question, when dealing with these plans if there is no allowed amount, can we charge them 20% of the billed charges?.

Any help would be appreciated!

Michele

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Re: Medicare Replacement Plans - Fee For Service
« Reply #1 on: February 24, 2010, 01:33:16 PM »
The thing to remember is even if it is a Medicare replacement plan, it is handled by a commercial carrier.  For example, American Progressive Today's Options doesn't require providers to 'enroll' with them.  By submitting the claim on behalf of the patient you are considered 'in network'.  It is important that you know each plan's rules.  They do have to abide by Medicare rules for what they allow etc, but they also instill there own as well on administrative things.  There should always be an allowed amount when dealing with Medicare (even replacement plans) so I would be careful when charging the patient.  You may want to call on one and get an explanation (specifically what is the patient responsibility).

Just when you get it all straight - it will change!  That's why we all love this business!

Michele
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Pay_My_Claims

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Re: Medicare Replacement Plans - Fee For Service
« Reply #2 on: February 24, 2010, 08:58:46 PM »
easy fix.....don't accept plans you are not in network with

MNelson

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Re: Medicare Replacement Plans - Fee For Service
« Reply #3 on: February 25, 2010, 02:40:31 PM »
Unfortunately there is no easy fix!  We do not participate with ANY health insurance carrier at this time.  We are still trying to establish medical need!  Makes things ohhh that much more difficult! 

And yes, just when you think heyyy i got this, it changes all over again!  :-\

Thanks ladies!


Pay_My_Claims

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Re: Medicare Replacement Plans - Fee For Service
« Reply #4 on: February 25, 2010, 06:18:08 PM »
well I feel your pain, my provider isn't par with anyone either. ..well Medicare N Medicaid