Author Topic: Patient with Commercial and Medicare Insurance  (Read 100 times)

Yazj42

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Patient with Commercial and Medicare Insurance
« on: February 19, 2021, 08:32:26 AM »
Hi Everyone! I have a question about patient's insurance.

I had a patient come in and they presented me with a POS commercial plan and a Medicare card. The patient is under the age of 65, but he has end stage renal disease. When I called his commercial insurance, they said they have no record of his Medicare enrollment. When I go onto the WPS website, there is no indication that he has a commercial plan or an MCO plan, or a secondary. Which insurance do I bill?

Michele

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Re: Patient with Commercial and Medicare Insurance
« Reply #1 on: February 22, 2021, 07:11:41 AM »
I'm assuming the WPS website is the Medicare website?  So are you saying Medicare is showing that he has part B but doesn't show his commercial plan.   And his commercial plan doesn't show his Medicare plan.  I would have the patient contact Medicare to get this straightened out because it will really mess things up.  There really is no way to know which one is primary until he gets Medicare to coordinate benefits with his commercial insurance.  If he is retired, Medicare is primary, but if he's still working, it will depend on how many employees their are, etc.
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