First Medigap Plan at 80+

[Ariadne22]

"PPO" is the issue. Medigaps are not "PPO." "PPO" means preferred provider organization - which implies a provider network. Medigaps don't have provider networks.

If Medicare doesn't submit the billing to GHI, you will have to. GHI should have claim forms you can use for that purpose. In which case, you would pay the provider its 20%, and GHI would reimburse you.

Again, it appears you won't know anything for sure until you actually use this insurance in FL.

[NextExit40Miles]

Originally Posted by Ariadne22

"PPO" is the issue. Medigaps are not "PPO." "PPO" means preferred provider organization - which implies a provider network. Medigaps don't have provider networks.

If Medicare doesn't submit the billing to GHI, you will have to. GHI should have claim forms you can use for that purpose. In which case, you would pay the provider its 20%, and GHI would reimburse you.

Again, it appears you won't know anything for sure until you actually use this insurance in FL.

Yes you're absolutely right. PPO is my concern and probably why Florida said they don't accept GHI as it's 'out of their network'. Though if they do just bill Medicare (see below) then why was that a concern to them ?

I'll share this... my mother just received a hospital bill, I called to find out what it was about. Anyway, I then asked who exactly did you bill ? She told me, they just billed Medicare (only Medicare) and that Medicare then sends the bill(s) to GHI or whomever. So it does seem that what GHI told me was correct in that I need only give the doctor my parents Medicare card and Medicare will 'take care of the rest'. Though this doesn't explain why every doctor they've ever gone to always asks for both cards ?

But anyway, as you said... it appears you won't know anything for sure until you actually use this insurance in FL.

Given that, to 'test things out' I'd like to bring my mother to a doctor when we're down there for a visit, though I'm not sure if that would be appropriate to do. So, if I were to bring her instead to an Urgent Care (maybe a little more appropriate ) would the billing be the same and give me the insight into how Florida and Medicare/GHI will handle this when we move down ? Any thoughts ?

I'd much rather test drive first before I buy.

[Ariadne22]

I've used Urgent Care here and their insurance procedure does not differ from a doctor's office or clinic. Urgent care will do as every provider does - submit the claim to Medicare.

[NextExit40Miles]

Originally Posted by Ariadne22

I've used Urgent Care here and their insurance procedure does not differ from a doctor's office or clinic. Urgent care will do as every provider does - submit the claim to Medicare.

Thank you again Ariadne22.

If we ever do get down there considering the current situation, I'll follow up with my findings as it may help others in a similar position.