Wiki Medicare payments ??

[mitzfritz215]

We have a Pt that had Universal Ins. HMO. The doctor I work for is out of network. The Pt was in the hospital in 2010. Universal denied as Pt met the $50k cap for out of network. She now has Medicare since 01-01-2011. I billed Medicare and they denied reading other ins (or something like that) available. If I let Medicare know that Universal capped out will they pay? Just not sure???????

 

[jjw0118]

possible answer

first you have to find out if she still has universal insurance and if she does not then she needs to notify Medicare that she no longer has that insurance and medicare is her primary. Number 2 is she over 65? is her Medicare part A or A and B? Once she gets Medicare notified, then you can refile the claim electronicly for payment and it should be covered.