Quote:
Originally Posted by RemydeHaviland  I am not entirely clear on the circumstances
If you have two plans - Medicare and a Supplement of some sort, then it sounds like confusion based on their interaction / overlap
It sounds like Medicare is denying based on the fact that another insurance plan would have been "primary", ie - Medicare was not the primary "provider of coverage"
This could be the result of a coding issue by the service provider (hospital / physician, etc), as another poster mentioned
I would investigate further and see which plan would be "primary" for emergent care
Best of luck getting things resolved! |
Her husband, Jack had two coverages, Medicare as
Primary and a Supplement (PPO) as
Secondary. The hospital was a Medicare authorized facility although, the ER Attending Physician who cared for her husband was
not.
Thus, Medicare denied payment to the ER Attending Physician because he was
not an "authorized" provider of Medicare.