Wiki New York State Empire Plan secondary coverage (non-payment)

[sharonc2222]

We have several patients that have Medicare as primary and the Empire Plan, a UHC plan for New York State employees. If Medicare does not covers certain services, it automatically forwards to UHC. UHC denies saying they have no obligation to pay as secondary unless there is a patient responsibility, which there is not because Medicare does not cover the services billed. Interestingly, we bill the same services to the Empire Plan when patients have it as primary and the services are paid. At first I thought it was because the member's plan was a retirement plan, but then we also have patients on Medicare as a disabled with LGHP, Empire Plan being the LGHP as their spouse is still working and their plan will not pay it either. We have appealed in the past and been denied, saying that the original determination has been upheld.

Trying to figure out if The Empire Plan would pay if we had an ABN on file or if perhaps there are just certain governed provisions for secondary coverage since it's through the State for their employees. If anyone has had any success with them paying as secondary for non-covered Medicare services or just has information to explain why they don't pay, or any other ideas please share your insights