Insurance coordination

[sweetie]

I was wondering if anyone was familiar with how benefits coordinate with one another. Here is my example: Blue Cross/Blue Shield and Medicare.

I will have Blue Cross and Blue Shield of Minnesota when I get married as primary and Medicare as secondary. But have yet to receive a straight answer as to how these will coordinate to pay my medical bills.

Examples include: what will be paid if I go in-network vs. out-of-network by Medicare. (my bc/bs pays 80/20 in network and 70/30 of R&C out-of-network...but I am unsure about how the remainder will be picked up by Medicare. I do have an out-of-pocket max for In-network of $2,000. Is there anyone with knowledge about this or who might be in my situation that can shed some light onto this--both on outpatient and inpatient visits?? I fear getting stuck with some huge bills<img src="i/expressions/face-icon-small-sad.gif" border="0">

sweetie

 

[sweetie]

I was wondering if anyone was familiar with how benefits coordinate with one another. Here is my example: Blue Cross/Blue Shield and Medicare.

I will have Blue Cross and Blue Shield of Minnesota when I get married as primary and Medicare as secondary. But have yet to receive a straight answer as to how these will coordinate to pay my medical bills.

Examples include: what will be paid if I go in-network vs. out-of-network by Medicare. (my bc/bs pays 80/20 in network and 70/30 of R&C out-of-network...but I am unsure about how the remainder will be picked up by Medicare. I do have an out-of-pocket max for In-network of $2,000. Is there anyone with knowledge about this or who might be in my situation that can shed some light onto this--both on outpatient and inpatient visits?? I fear getting stuck with some huge bills<img src="i/expressions/face-icon-small-sad.gif" border="0">

sweetie

 

[sweetie]

I was wondering if anyone was familiar with how benefits coordinate with one another. Here is my example: Blue Cross/Blue Shield and Medicare.

I will have Blue Cross and Blue Shield of Minnesota when I get married as primary and Medicare as secondary. But have yet to receive a straight answer as to how these will coordinate to pay my medical bills.

Examples include: what will be paid if I go in-network vs. out-of-network by Medicare. (my bc/bs pays 80/20 in network and 70/30 of R&C out-of-network...but I am unsure about how the remainder will be picked up by Medicare. I do have an out-of-pocket max for In-network of $2,000. Is there anyone with knowledge about this or who might be in my situation that can shed some light onto this--both on outpatient and inpatient visits?? I fear getting stuck with some huge bills<img src="i/expressions/face-icon-small-sad.gif" border="0">

sweetie

 

[sweetie]

I was wondering if anyone was familiar with how benefits coordinate with one another. Here is my example: Blue Cross/Blue Shield and Medicare.

I will have Blue Cross and Blue Shield of Minnesota when I get married as primary and Medicare as secondary. But have yet to receive a straight answer as to how these will coordinate to pay my medical bills.

Examples include: what will be paid if I go in-network vs. out-of-network by Medicare. (my bc/bs pays 80/20 in network and 70/30 of R&C out-of-network...but I am unsure about how the remainder will be picked up by Medicare. I do have an out-of-pocket max for In-network of $2,000. Is there anyone with knowledge about this or who might be in my situation that can shed some light onto this--both on outpatient and inpatient visits?? I fear getting stuck with some huge bills<img src="i/expressions/face-icon-small-sad.gif" border="0">

sweetie

 

[sweetie]

I was wondering if anyone was familiar with how benefits coordinate with one another. Here is my example: Blue Cross/Blue Shield and Medicare.
<br />
<br />I will have Blue Cross and Blue Shield of Minnesota when I get married as primary and Medicare as secondary. But have yet to receive a straight answer as to how these will coordinate to pay my medical bills.
<br />
<br />Examples include: what will be paid if I go in-network vs. out-of-network by Medicare. (my bc/bs pays 80/20 in network and 70/30 of R&C out-of-network...but I am unsure about how the remainder will be picked up by Medicare. I do have an out-of-pocket max for In-network of $2,000. Is there anyone with knowledge about this or who might be in my situation that can shed some light onto this--both on outpatient and inpatient visits?? I fear getting stuck with some huge bills<img src="i/expressions/face-icon-small-sad.gif" border="0">
<br />
<br />sweetie

 

[Asexyblond23]

Im not much help here, but I know when they messed my tircare up for my IV's and told them I was 80/20 the only thing that they free medicare pays for is like doctor visits. It doesnt cover meds or ivs and i dont think hospital stays but dont quote me on that one. So I would have had to pay the 20% b/c the free medicare ( Part A ) didnt cover iv meds or home nursing. Best thing to do is call medicare and ask them what you have with them and what it covers then you will know if medicare should pick up and cover something or if its not covered.

 

[Asexyblond23]

Im not much help here, but I know when they messed my tircare up for my IV's and told them I was 80/20 the only thing that they free medicare pays for is like doctor visits. It doesnt cover meds or ivs and i dont think hospital stays but dont quote me on that one. So I would have had to pay the 20% b/c the free medicare ( Part A ) didnt cover iv meds or home nursing. Best thing to do is call medicare and ask them what you have with them and what it covers then you will know if medicare should pick up and cover something or if its not covered.

 

[Asexyblond23]

Im not much help here, but I know when they messed my tircare up for my IV's and told them I was 80/20 the only thing that they free medicare pays for is like doctor visits. It doesnt cover meds or ivs and i dont think hospital stays but dont quote me on that one. So I would have had to pay the 20% b/c the free medicare ( Part A ) didnt cover iv meds or home nursing. Best thing to do is call medicare and ask them what you have with them and what it covers then you will know if medicare should pick up and cover something or if its not covered.

 

[Asexyblond23]

Im not much help here, but I know when they messed my tircare up for my IV's and told them I was 80/20 the only thing that they free medicare pays for is like doctor visits. It doesnt cover meds or ivs and i dont think hospital stays but dont quote me on that one. So I would have had to pay the 20% b/c the free medicare ( Part A ) didnt cover iv meds or home nursing. Best thing to do is call medicare and ask them what you have with them and what it covers then you will know if medicare should pick up and cover something or if its not covered.

 

[Asexyblond23]

Im not much help here, but I know when they messed my tircare up for my IV's and told them I was 80/20 the only thing that they free medicare pays for is like doctor visits. It doesnt cover meds or ivs and i dont think hospital stays but dont quote me on that one. So I would have had to pay the 20% b/c the free medicare ( Part A ) didnt cover iv meds or home nursing. Best thing to do is call medicare and ask them what you have with them and what it covers then you will know if medicare should pick up and cover something or if its not covered.

 

[Aspiemom]

I'll try to help you. My husband's company has fewer than 100 employees so Medicare is my Primary and BC/BS of TN is my Secondary, but I've had it switched around before.

Do you not have the annual handbook Medicare mails out? It lists what is covered and all.

Re hospital stays it says <i>Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in acute care hospitals, inpatient care as part of a clinical research study and mental health care. This doesn't include private-duty nursing or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.</i>

Your BC/BS would pay first - whatever their plan pays - and the balance goes to Medicare.

When I've received Home Health Care and IV's, Medicare would pay for the nurses, but not the Infusion aspect. I believe they pay for Infusion coverage in the hospital, but not at home but I'm not absolutely sure about this.

If you don't have a Handbook, I recommend you call Medicare and request one because they are supposed to send you one.

Feel free to PM me if you have other questions.

 

[Aspiemom]

I'll try to help you. My husband's company has fewer than 100 employees so Medicare is my Primary and BC/BS of TN is my Secondary, but I've had it switched around before.

Do you not have the annual handbook Medicare mails out? It lists what is covered and all.

Re hospital stays it says <i>Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in acute care hospitals, inpatient care as part of a clinical research study and mental health care. This doesn't include private-duty nursing or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.</i>

Your BC/BS would pay first - whatever their plan pays - and the balance goes to Medicare.

When I've received Home Health Care and IV's, Medicare would pay for the nurses, but not the Infusion aspect. I believe they pay for Infusion coverage in the hospital, but not at home but I'm not absolutely sure about this.

If you don't have a Handbook, I recommend you call Medicare and request one because they are supposed to send you one.

Feel free to PM me if you have other questions.

 

[Aspiemom]

I'll try to help you. My husband's company has fewer than 100 employees so Medicare is my Primary and BC/BS of TN is my Secondary, but I've had it switched around before.

Do you not have the annual handbook Medicare mails out? It lists what is covered and all.

Re hospital stays it says <i>Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in acute care hospitals, inpatient care as part of a clinical research study and mental health care. This doesn't include private-duty nursing or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.</i>

Your BC/BS would pay first - whatever their plan pays - and the balance goes to Medicare.

When I've received Home Health Care and IV's, Medicare would pay for the nurses, but not the Infusion aspect. I believe they pay for Infusion coverage in the hospital, but not at home but I'm not absolutely sure about this.

If you don't have a Handbook, I recommend you call Medicare and request one because they are supposed to send you one.

Feel free to PM me if you have other questions.

 

[Aspiemom]

I'll try to help you. My husband's company has fewer than 100 employees so Medicare is my Primary and BC/BS of TN is my Secondary, but I've had it switched around before.

Do you not have the annual handbook Medicare mails out? It lists what is covered and all.

Re hospital stays it says <i>Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in acute care hospitals, inpatient care as part of a clinical research study and mental health care. This doesn't include private-duty nursing or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.</i>

Your BC/BS would pay first - whatever their plan pays - and the balance goes to Medicare.

When I've received Home Health Care and IV's, Medicare would pay for the nurses, but not the Infusion aspect. I believe they pay for Infusion coverage in the hospital, but not at home but I'm not absolutely sure about this.

If you don't have a Handbook, I recommend you call Medicare and request one because they are supposed to send you one.

Feel free to PM me if you have other questions.

 

[Aspiemom]

I'll try to help you. My husband's company has fewer than 100 employees so Medicare is my Primary and BC/BS of TN is my Secondary, but I've had it switched around before.
<br />
<br />Do you not have the annual handbook Medicare mails out? It lists what is covered and all.
<br />
<br />Re hospital stays it says <i>Semi-private room, meals, general nursing, and other hospital services and supplies. This includes inpatient care you get in acute care hospitals, inpatient care as part of a clinical research study and mental health care. This doesn't include private-duty nursing or a television or telephone in your room. It also doesn't include a private room, unless medically necessary. Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.</i>
<br />
<br />Your BC/BS would pay first - whatever their plan pays - and the balance goes to Medicare.
<br />
<br />When I've received Home Health Care and IV's, Medicare would pay for the nurses, but not the Infusion aspect. I believe they pay for Infusion coverage in the hospital, but not at home but I'm not absolutely sure about this.
<br />
<br />If you don't have a Handbook, I recommend you call Medicare and request one because they are supposed to send you one.
<br />
<br />Feel free to PM me if you have other questions.

 

[Juliet]

When I had BC/BS with another private insurance they went by the "birthday rule". Whomever's Bday is first is primary, the other secondary. In my case my hubby's insurance covered 90% (or something like that) so his paid first. THen the balance went to BC/BS (my company insurance). BC/BS said we only cover 90% and since 90% has already been paid we pay nothing. I tried for a year to get them to pay 90% of the 10% balance but they would never do it despite many many appeals. So we ended up just dropping one family plan and only keep BC/BS since premium copays though my company are less than through hubby's.

I don't know if they use the same Bday rule with Medicare. Since that's not private it might fall into a different set of coordination of benefit rules. BTW, BC/BS should provide documentation about "Coordination of Benefits" (whether it's understandable is another matter...) <img src="i/expressions/face-icon-small-wink.gif" border="0"> ~Juliet

 

[Juliet]

When I had BC/BS with another private insurance they went by the "birthday rule". Whomever's Bday is first is primary, the other secondary. In my case my hubby's insurance covered 90% (or something like that) so his paid first. THen the balance went to BC/BS (my company insurance). BC/BS said we only cover 90% and since 90% has already been paid we pay nothing. I tried for a year to get them to pay 90% of the 10% balance but they would never do it despite many many appeals. So we ended up just dropping one family plan and only keep BC/BS since premium copays though my company are less than through hubby's.

I don't know if they use the same Bday rule with Medicare. Since that's not private it might fall into a different set of coordination of benefit rules. BTW, BC/BS should provide documentation about "Coordination of Benefits" (whether it's understandable is another matter...) <img src="i/expressions/face-icon-small-wink.gif" border="0"> ~Juliet

 

[Juliet]

When I had BC/BS with another private insurance they went by the "birthday rule". Whomever's Bday is first is primary, the other secondary. In my case my hubby's insurance covered 90% (or something like that) so his paid first. THen the balance went to BC/BS (my company insurance). BC/BS said we only cover 90% and since 90% has already been paid we pay nothing. I tried for a year to get them to pay 90% of the 10% balance but they would never do it despite many many appeals. So we ended up just dropping one family plan and only keep BC/BS since premium copays though my company are less than through hubby's.

I don't know if they use the same Bday rule with Medicare. Since that's not private it might fall into a different set of coordination of benefit rules. BTW, BC/BS should provide documentation about "Coordination of Benefits" (whether it's understandable is another matter...) <img src="i/expressions/face-icon-small-wink.gif" border="0"> ~Juliet

 

[Juliet]

When I had BC/BS with another private insurance they went by the "birthday rule". Whomever's Bday is first is primary, the other secondary. In my case my hubby's insurance covered 90% (or something like that) so his paid first. THen the balance went to BC/BS (my company insurance). BC/BS said we only cover 90% and since 90% has already been paid we pay nothing. I tried for a year to get them to pay 90% of the 10% balance but they would never do it despite many many appeals. So we ended up just dropping one family plan and only keep BC/BS since premium copays though my company are less than through hubby's.

I don't know if they use the same Bday rule with Medicare. Since that's not private it might fall into a different set of coordination of benefit rules. BTW, BC/BS should provide documentation about "Coordination of Benefits" (whether it's understandable is another matter...) <img src="i/expressions/face-icon-small-wink.gif" border="0"> ~Juliet

 

[Juliet]

When I had BC/BS with another private insurance they went by the "birthday rule". Whomever's Bday is first is primary, the other secondary. In my case my hubby's insurance covered 90% (or something like that) so his paid first. THen the balance went to BC/BS (my company insurance). BC/BS said we only cover 90% and since 90% has already been paid we pay nothing. I tried for a year to get them to pay 90% of the 10% balance but they would never do it despite many many appeals. So we ended up just dropping one family plan and only keep BC/BS since premium copays though my company are less than through hubby's.
<br />
<br />I don't know if they use the same Bday rule with Medicare. Since that's not private it might fall into a different set of coordination of benefit rules. BTW, BC/BS should provide documentation about "Coordination of Benefits" (whether it's understandable is another matter...) <img src="i/expressions/face-icon-small-wink.gif" border="0"> ~Juliet