How Does Part B Work? What's to Stop Insurers From Denying Your Claim? (55, supplement)
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If I understand Part B, it's provided by private insurers to plug the gap left by Part A, which covers only 80%. So you have a $100,000 hospital bill. Medicare pays $80,000. What to stop the insurance pimps from stamping your remaining $20,000 "Denied" just like they do with regular private pay customers?
Not trying to be sarcastic, but what you have written isn't anywhere close to being correct. Both Part A and Part B are Government-run operations. Part A covers hospitalizations and is paid for by the 1.45% payroll tax that all workers pay. Part B is optional, is paid with monthly premiums, and covers medical outpatient medical services such as doctor visits and lab tests.
I suggest that you go to medicare.gov to learn more.
But there is a valid question if you tease out the intent from the confusion of the OP over Part B which is the Medicare portion with the real question of supplemental insurance which is a private insurance that some people buy.
I don't know the answer but I suspect that the private supplemental insurance policies are subject to whatever caveats the individual policy has. I don't know if this has been an issue so far or not.
I have AARP supplemental to go along with my Medicare.
My plan covers the 20% that Medicare doesn't as well as the deductible, and extends the hospitalization time limits.
I have never had to pay anything and nothing has ever been denied.
The representative told me that if Medicare approves the original claim, they don't question it and automatically pay their part.
If Medicare denies the claim, the supplemental may still pay it pending a review of the particular case.
Part C and Part D are where the private insurers come in. This is insurance you have to pay for in addition to paying for Part B.
All you get for free with Medicare is Part A -- Major Hospitalization.
Everything else (Parts B, C and D) come with a monthly fee and covers what private insurance covers: doctors visits, tests, xrays, maybe dental and glasses (depending on the carrier), prescriptions.
Go to the Medicare website and download the book: Medicare and You. It's in PDF. That will explain it all. Medicare.gov - The Official U.S. Government Site for People with Medicare
Or just browse through the site. It will explain the different plans.
If you opt for Part B only, and don't get the supplemental or Advantage plan provided in part C, you can end up paying large chunks of cash for the percentage Medicare doesn't cover.
This is where Supplemental and Advantage plans come in. For an additional amount each month, they cover you, or they may not. It depends on the plan.
Getting the right Medicare supplemental/advantage plan is very important. Your quality of life may depend on it. You need to really spend some time -- and it takes a lot of time -- to study and understand the options.
Many adfvanatge plans can really be limiting as to where you can be treated;by who and even what they will pay fop0r;so check before you signup because it takes time to switch back.Approval alos is often slow for anyhting rom them. They also oftwen employ physicain that can liteally take over from your doctors as to what trweatment to will get.
Many adfvanatge plans can really be limiting as to where you can be treated;by who and even what they will pay fop0r;so check before you signup because it takes time to switch back.Approval alos is often slow for anyhting rom them. They also oftwen employ physicain that can liteally take over from your doctors as to what trweatment to will get.
Medicare obviously can get to be quite an emotional issue. [d b0e y8yp0ing th5at waiy tuo/ See what i mean???
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If you opt for Part B only, and don't get the supplemental or Advantage plan provided in part C, you can end up paying large chunks of cash for the percentage Medicare doesn't cover.
That's what I was trying to figure out. Minus part C you're in deep sh*t if you incur big bills and only have Part B.
If I understand Part B, it's provided by private insurers to plug the gap left by Part A, which covers only 80%. So you have a $100,000 hospital bill. Medicare pays $80,000. What to stop the insurance pimps from stamping your remaining $20,000 "Denied" just like they do with regular private pay customers?
Private insurance is called MedAdvantage and it is Part C of Medicare. It includes A and B when Medicare pays a private insurance company your premium and they foot the bill. You pay co-pays but there is hardly ever co-insurance.
Many adfvanatge plans can really be limiting as to where you can be treated;by who and even what they will pay fop0r;so check before you signup because it takes time to switch back.Approval alos is often slow for anyhting rom them. They also oftwen employ physicain that can liteally take over from your doctors as to what trweatment to will get.
I don't know where the doctors taking over comes in. That would be something new to the Medicare program. Medicare Advantage is Medicare with a private insurance company under which you are covered. Medicare pays your premium for your policy which HAS to be better or equal to the coverage provided in parts A and B. A, B, and C are highly regulated by CMS. Part C may not even require a monthly premium but only co-pays (10 -50 dollars when you see a practitioner) But there are different kinds of policies, HMO, PPO, POS, and PFFS. PFFS - Private fee for service is where a doctor can decide if they will take the plan. But you can go to any doctor.
Medical Supplements or Medigap is when you have A and B so you would be responsible for 20% co insurance, a deductible, and part B has a monthly payment required. Medical Supplements have a monthly premium. Medicare Supplements are not regulated by CMS but by the Insurance Commissioner.
All this can be found at Medicare.gov or you can talk to a broker in your area that can compare your situation with the plan that might work best.
Hope that helps
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