Need help understanding Medicare quarterly statement

L

Lolly

Member
Location
Chicago Area
My husband and I are new to Medicare.. In April, My husband had surgery... He has met his $183 Medicare part B deductible. We have received a Medicare summary outlining all the bills they received for the previous quarter. There is a section saying "Amount you may have to pay providers" and it listed the total of $800 unapproved charges... It was my understanding that when you have traditional Medicare part A and B.. and a Supplemental policy.. which we do.. that we are not responsible for paying anything more.. Unless we were advised in advance and given a consent form.

I guess I just don't understand why Medicare is telling us we may have to pay another $800. We have Blue Cross supplemental Plan G and have paid our deductible. Can Doctors bill us more?
 

It said "may". Medicare should bill your 2nd policy automatically. If they don't call your providers and be sure they have your 2nd policy info. When I worked collections we always billed the 2nd policy if we had the info. So always when you see a doctor or go into the hospital tell them you have a secondary policy so they can bill it . A lot of times we would bill the patient as they did not inform us of their other coverage. After that policy was billed the patient seldom had any responsibility according to their policy coverage. Talk to the office managers because they are willing to help get your claims paid ASAP. I also made sure the insurance companies and medicare paid what they were supposed to before I billed a patient.
 
I'm not sure Lolly, but they sure do throw big numbers at you that causes you to worry. I don't have a supplement to my Medicare so I haven't dealt with that. What I have done is wait until an actual bill shows up before I fret because the best I figure you don't know for sure exactly what is going on.
 

Well, I know the providers have the supplement information.. as anytime we go to a new one, they copy both our Medicare cards and our BC/BS cards. Guess I'll wait until any bills come... but I was told by our insurance agent that the only check I am responsible for is the $183 Part B deductible and with Plan G, there is no out of pocket after that... so I have no idea why Medicare says I may owe more money.. I was just wondering if anyone else had Medicare tell them that on the quarterly statement.
 
Lolly, I've dealt with this for some time on behalf of both my sister and myself, and for a friend.

After much fretting and fussing over this this is what I've learned:

1. Most (if not all) Medicare providers accept "assignment" of your Medicare benefits as payment for their services.

2. Most providers bill Medicare their regular charges anyway.

3. Medicare pays their portion of the allowable charge.

4. Medicare doesn't know or care about your supplemental insurance, so the unpaid portion shows up on the Medicare EOB as "you may be billed."

5. Provider bills the supplement for the rest of the allowable charge.

6. After the supplement pays the rest of the Medicare allowable, the provider writes off the rest.

This is the way it is supposed to work, and how it usually DOES work. My sister got bills from her providers when she was on a supplement that was very slow-pay and we had to go round and round with that supplement to get their portion paid.

BUT, don't fret about that Medicare quarterly statement -- those are issued to everybody and ONLY show the part that basic Medicare paid and do not reflect any amounts expected to be paid by your supplement or any amounts that the provider will write off. It ONLY reflects the part that basis Medicare paid.

So take a deep breath.
 
Butterfly said:
Lolly, I've dealt with this for some time on behalf of both my sister and myself, and for a friend.

After much fretting and fussing over this this is what I've learned:

1. Most (if not all) Medicare providers accept "assignment" of your Medicare benefits as payment for their services.

2. Most providers bill Medicare their regular charges anyway.

3. Medicare pays their portion of the allowable charge.

4. Medicare doesn't know or care about your supplemental insurance, so the unpaid portion shows up on the Medicare EOB as "you may be billed."

5. Provider bills the supplement for the rest of the allowable charge.

6. After the supplement pays the rest of the Medicare allowable, the provider writes off the rest.

This is the way it is supposed to work, and how it usually DOES work. My sister got bills from her providers when she was on a supplement that was very slow-pay and we had to go round and round with that supplement to get their portion paid.

BUT, don't fret about that Medicare quarterly statement -- those are issued to everybody and ONLY show the part that basic Medicare paid and do not reflect any amounts expected to be paid by your supplement or any amounts that the provider will write off. It ONLY reflects the part that basis Medicare paid.

So take a deep breath.
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That sounds right. The big problem/scare is some of the hyper inflated amounts that show up in places. It's like we are giving you such a deal, $10 for an aspirin instead of the $100 we could/should have charged you... and you never know we might... BOO! LOL
 
Lolly said:
My husband and I are new to Medicare.. In April, My husband had surgery... He has met his $183 Medicare part B deductible. We have received a Medicare summary outlining all the bills they received for the previous quarter. There is a section saying "Amount you may have to pay providers" and it listed the total of $800 unapproved charges... It was my understanding that when you have traditional Medicare part A and B.. and a Supplemental policy.. which we do.. that we are not responsible for paying anything more.. Unless we were advised in advance and given a consent form.

I guess I just don't understand why Medicare is telling us we may have to pay another $800. We have Blue Cross supplemental Plan G and have paid our deductible. Can Doctors bill us more?
Click to expand...

I get that too. That $800 is just what Medicare hasn't paid. Then your BCBS supplement will kick in. I have a BCBS supplement too and I pay almost nothing once the dust has settled. That's includes the annual Medicare deductible. It's almost always covered by the BCBS supplement. I never pay anything until I am absolutely certain that everything has been through both insurances. And even then I will call one or both of the insurances to make sure they have paid everything they are going to. Sometimes the providers don't file it correctly. BCBS is pretty nit picky. If the provider gets just one digit wrong when they are imputing your policy number BCBS will kick it back. So sometimes you have to follow through. I've had two instances where the providers failed to file everything. Then like two years later someone finds it and sends it in to BCBS and they deny it because it wasn't filed in a timely manner. Both times the providers tried to come back on me and try to collect the whole bill from me. I guess some people go ahead and pay it but not me. Their contract with BCBS requires that they file a timely manner, I think it's one year, or they are SOL. You as the patient are not responsible for that.
 
OOOOOHHHHH... Now that makes sense! Of course Medicare doesn't know or care about our BC/BS supplement.. That is why the "Your MAY owe" shows up.. Certainly was enough to scare the Bejebus out of me.. I have learned one thing though.. Never pay a single penny until I get a bill... That includes the Part B Deductible. I paid my $183.00 when I went to the doc and his billing service applied it to an old disputed balance from when I had commercial insurance. They have promised me a refund.. Live and learn.
 
Lolly said:
OOOOOHHHHH... Now that makes sense! Of course Medicare doesn't know or care about our BC/BS supplement.. That is why the "Your MAY owe" shows up.. Certainly was enough to scare the Bejebus out of me.. I have learned one thing though.. Never pay a single penny until I get a bill... That includes the Part B Deductible. I paid my $183.00 when I went to the doc and his billing service applied it to an old disputed balance from when I had commercial insurance. They have promised me a refund.. Live and learn.
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That's for sure. I've had a few instances in my life where I've overpaid something. I've found that getting a refund can be a lot like pulling teeth.
 
Trade said:
That's for sure. I've had a few instances in my life where I've overpaid something. I've found that getting a refund can be a lot like pulling teeth.
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That's what I didn't understand.. I thought I could write a check for my full deductible and be done with it for the year.. Thought I was doing a good thing. In reality, I had not incurred enough approved Medicare charges to fulfill that deductible, so I overpaid.
 
Lolly said:
That's what I didn't understand.. I thought I could write a check for my full deductible and be done with it for the year.. Thought I was doing a good thing. In reality, I had not incurred enough approved Medicare charges to fulfill that deductible, so I overpaid.
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Better to pay as you go, I think. Paying ahead probably fouls up their books. At the firm I worked for, my electronic bookkeeping system would not let me accept payments for which there was no bill to which to apply the payment. I had one instance where a client paid ahead and the system incorrectly applied it and it took me for freakin' ever to straighten it out. If I took a payment for which there was no invoice, I had to either create a "dummy" one or deposit the money into trust, and either alternative caused headaches right and left.

Many electronic bookkeeping systems (which everybody uses nowdays) make their own decisions about where to apply payments and those decisions can be difficult to override.
 
Butterfly said:
Better to pay as you go, I think. Paying ahead probably fouls up their books. At the firm I worked for, my electronic bookkeeping system would not let me accept payments for which there was no bill to which to apply the payment. I had one instance where a client paid ahead and the system incorrectly applied it and it took me for freakin' ever to straighten it out. If I took a payment for which there was no invoice, I had to either create a "dummy" one or deposit the money into trust, and either alternative caused headaches right and left.

Many electronic bookkeeping systems (which everybody uses nowdays) make their own decisions about where to apply payments and those decisions can be difficult to override.
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Back when I was in college I was getting some social security because both my parents were dead. Back then you could get that up to age 22 as long as you were in school. In the summer of 1968 my uncle in New Jersey hooked me up with a summer job in construction and I made pretty good money for those three months. That put me in the position of having made over the limit for getting those social security payments. I did not want my checks to stop, so silly me, I calculated how much money I was going to have to give them back and sent them a check for that amount. Well a few months later I got a letter from Social Security saying "You made too much money last year so we're going to stop your checks until the amount you were overpaid is satisfied." And that's what they did. No mention of the fact that I had already sent them a check for that amount. I finally did get a refund for the check I had sent them but it took a long time and was a big hassle.

Another time I made a mistake paying my utility bills. My electric bill was something like $155 bucks and my water bill was something like $22 bucks. I screwed up and sent the electric company a check for $22 and the water company a check for $155. Right away I got a letter from the electric company saying they wanted the rest of their money NOW or they would shut my power off. But not a peep from the water company. When I discovered my mistake I tried to get a refund from the water company, but all they said they would do is carry the extra I had paid as a credit and apply it to my future bills. So I had to come up with another $130 bucks for the electric company and be satisfied with not having to pay a water bill for almost the next year. This happened at a time when I didn't have an extra $130 to spare.

I call this the ratchet wrench effect. It's easy to turn in one direction, but hard in the other.
 

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