Wiki Medigap refunds go to patient?

[msresan]

I've been having a devil of a time finding (in writing) language that states the a Medigap policy that pays duplicate to an individual's 2ndary policy should be refunded to the patient. In the example I have Medicare processed, crossed claim over to both AARP supplement and a BCBS retiree benefit 2ndary plan. Both plans paid. When calling AARP, they stated that patient should get the refund because they COB only with Medicare and any credit created would be a patient credit--but I have not found anything in writing to this effect. I've tried CMS site reading about Medigap policies and COB issues with no luck.

 

[csperoni]

Hmmmm, this does not sound correct. It seems to me the patient needs to ensure their COB information with all carriers is correct. Both insurances should not pay the deductible or 20% co-insurance. Refunding the money to the patient means the patient is getting paid every time he/she gets medical care, and that can't possibly be correct. One of the carriers has to be secondary, and the other tertiary. You can't have 2 carriers secondary, just like you can't have 2 primary (assuming all carriers have the accurate COB information). I THINK it's supposed to be Medicare primary, Medigap secondary, and anything else tertiary (provided pt and/or spouse are retired).

 

[sls314]

That does not sound right to me either.

You can't have 2 secondary plans - one should be secondary and one should be tertiary. The tertiary payer should receive the refund.

If the patient is paying a premium for either the AARP plan or the BCBS retiree plan, they are completely wasting their money. They don't need both plans - one will consider the deductible/coinsurance after Medicare, and the other won't do anything.

I'm surprised that Medicare crossed the claim over to 2 different payors though - I'd think that somehow they might have caught that when setting up the crossover.