I worked for a major hospital for 25 years and incorrect coding was the major issue with claims. Coders are much to quick with applying codes to a charge just to move the volume of claims. It is actually a very lazy way to code and it creates a tremendous mess for the patient and facility with actually getting reimbursement smoothly. They should have a coding department that ONLY does Medicare billing and coding.
Having recently become eligible for Medicare I scheduled an annual wellness appointment w/ my provider. During the appt the Dr. suggested I get vaccinated against shingles and I was told the vaccine would be covered by insurance, so I completed the series of two shots several weeks apart. Medicare denied payment and upon investigating why found out the vaccine is not covered under Part B. However, the cost is covered under my Part D and if I'd had received the shots at my local pharmacy instead of the doctors office the claim would have been processed no problem. When I called the Atrium Health billing to request they bill CVS Caremark I was told they will not bill Part D insurance. So now I'm left to navigate the paperwork nightmare of asking Caremark to reimburse me for the $1k I'm out of pocket.
Email from Medicare this week QUOTE ... Medicare Part D now covers these vaccines and more at NO cost to you: Shingles RSV Tetanus/diphtheria (Td) Tetanus, diphtheria, and pertussis (whooping cough) (Tdap) Hepatitis A Hepatitis B, if you're at low risk for the virus Also, Medicare still covers flu shots, COVID-19 vaccines, and pneumococcal shots.
Before I was even 65 on medicare I was being treated for high blood pressure, acid reflux , chronic anemia, and high psa. So once you suspect an issue with your health they will pay for diagnostic tests or if being treated already prior to medicare they cover all the tests the doctor deems as necessary . The doctors know what medicare will pay for. Otherwise most people can’t pay out of pocket.
Please clear up a question I have. If I get a primary dr and make appointment for full panel bloodwork to start a baseline, and I have plan G supplemental what is my out of pocket? Just the $233. Deductible from Part B?
Hi,hope your doing well, could we send two claim for same patient, with same data of service under two different physical therapist. Please explain thanks
I was denied from getting a cat scan on my lungs. My doctor found a nodule in my left lung, said to get ct scan every 6 months to keep an eye on it. Last one I got medigap plan said they didn’t feel like I needed it. But my doctor said yes you do. Trying to deal with it. What to do?????
Someone as detailed about Medicare as you have shown can no doubt answer a rather difficult Question regarding HSA contributions in the year I turn 65. Specifically, I am wondering if the $1,000 catch-up amount can be contributed in full or does it need to be pro-rated by the number of months preceding my effective date? Example: 2023 HSA contribution is $3,850. My birthday is May 10 and my effective date is May 1st. So is my contribution 3,850 / 12 months = 320.83 x 4 = 1,283 plus the $1,000 for a total of $2280? OR is it 4,830 / 12 months = 402.50 x 4 = 1,610?
Wow! Your first Medicare issue just happened to me. I left my employer insurance for Original Medicare (I'm still working). I thought all was well. But every time I went to my Medicare account I'd see 2 insurances: Original Medicare and my company's health plan (which I had left). I checked for a couple of weeks thinking my employer plan would eventually be deleted, but it wasn't. So I had an online chat (I wanted it in writing--no phone call) with the Medicare rep to explain that I no longer had company insurance. Then she asked: So you want original Medicare to be your primary insurance? Duh! Of course I said yes. Now my employer insurance is off the site and only Original Medicare and my Plan D Rx plan are there. Whew! I managed to dodge a bullet. I haven't used the insurance yet, so I don't see my Medigap Plan there. My Supplement plan (United Healthcare) said once a doctor sends a claim, then Medicare will know I have a supplement. *I hope that is correct.* Always check your account to make sure things are in ordert!
This happens so often! It can often take a while for your supplement plan to show on your mymedicare.gov account but as long as your plan is active and premiums are paid, it should pay after Medicare approves a claim.
Hi, I'm a Medical biller from India who is working for the providers. So I understand what you're talking about. You don't have to worry about getting billed. Once Medicare approves the claim, the claim will be automatically forwarded to your medigap plan electronically..
Good morning. Can you please answer the following. I'm 59 and disabled. I waited 2 years to get my medicare card plan a and b. My medicare card started the beginning of this month. March 1, 2023. Until when do I have to get a medigap or advantage plan without penalty. Thank you and God Bless.
If Medigap is available in your area, then you would have until the end of August to get a Medigap plan without underwriting. You have until the end of June to get a Medicare Advantage plan. Call us for help! 888-465-9728
Hlo mam , why some agent choose bops for reaching to those customer (who are interested to know more about their Medicare additional plans) which are located in india pakistan or even in Bangladesh
The mistake that people make is thinking that MA companies are deciding what they will cover. That's not true. MA companies are using Medicare treatment guidelines to treat a person.
They should cover services based on what Traditional Medicare Parts A and B will cover, yes. But in depth reports by the OIG have uncovered that they deny more services than Traditional Medicare does. And once appealed, they over turn most of the initial denials of the claims which means they are regularly wrongly denying certain medical claims. This happens more often with certain Medicare Advantage companies.
@@AbtInsuranceAgency The OIG report you are referring to is a very limited l, very biased report that uses a very flawed methodology to arrive at their conclusions. The fact is that MA is really pushing the FWA of Medicare by doctors and hospitals out of the system. There are much more complete pictures of the FWA of Medicare.
If you ever have any real problems with Medicare, it is a black hole you can't escape that will suck all your strength and energy and peace of mind. Everyone will tell you something different and will treat you as a criminal even though you are the only one trying to get things sorted out.
@@Sollarose_mb7x8 I’ve never spoken to anyone with Medicare. My medicare card arrived in the mail and premiums were deducted from my social security payments.
I have watched a couple of videos where they have a way where Medicare or Advantage plans will cover one while living abroad! ⁉️ Do you care to comment on that?
Medicare Advantage plans (and most Medicare Supplement plans) offer *emergency* coverage when abroad. But if you plan to live abroad long term and receive non emergency care then Medicare and Medicare Advantage plans generally will not cover you.
