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Hey guys, Tony here. So you know I love answering your questions about Medicare and contracting and success
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So here's another question that came in tonight. What if a patient has a secondary insurance such as Blue Cross Blue Shield or Humana or UnitedHealthcare AARP
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If I am contracted with Medicare Part B but I'm not contracted with the secondary, will I get paid
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So let's clear up some confusion about secondary payers. Typically, in this scenario, we're going to assume Medicare Part B is the primary
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and we're going to assume you are contracted with Medicare Part B. There's multiple kinds of secondary insurance
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Secondary just means that it's another plan in the second position. But a supplemental, also known as a Medigap, is a kind of secondary
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A supplemental can only be sold to individuals who have traditional Medicare Part B
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A supplemental will typically have a letter associated with it and based on that letter you know how much of the Medicare deductible or the Medicare coinsurance that supplemental plan will pay If you don know about this I going to put a video up here that I shared a while back that
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explains how you can tell what the supplemental is going to pick up. So if the secondary insurance
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is a supplemental Medigap plan you do not need to be individually contracted with that secondary
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They will pay you whatever amount they're going to pay based on the 20% if you're contracted with Medicare and you're participating with Medicare
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So it's really simple. And in most of those cases, I can't even think of a time that it hasn't worked like this
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You'll submit the claim to Medicare as the primary. Medicare will auto-crossover and forward the claim to the supplemental
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There won't be anything for you to do on your part. If you're submitting claims electronically, typically Medicare will pay in about 12 days
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Then it'll forward that to the supplemental. The supplemental from that, the time that Medicare finished processing, the supplemental
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then will kick in but it could be two weeks four weeks six weeks longer Every supplemental is going to be a little bit different So know that if you submitting claims electronic to Medicare Part B you get paid in about 12 days maybe 10
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maybe 14. If you're submitting via paper, it could be as long as 30 days. But then it goes
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to the supplemental and that could be two weeks, four weeks, six weeks, whatever they're doing
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The other kind of secondary, the other kind of popular secondary, it's not a supplemental
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it's actually it's typically a spouse's plan it's a traditional insurance policy and in those cases
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the secondary will not pay you if you're not a contracted provider with them and there is no
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out-of-network coverage the secondary in those cases might have its own copay which isn't uncommon
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we had a case a couple years ago where the individual had medicare primary the 20 co-insurance
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worked out to about $23 per visit, but the secondary was a non-supplemental plan. It was a
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spouse policy and it actually had a copay So even though the balance due was when it went to the secondary it processed with the copay So really the secondary didn end up picking up anything in that case Now if Medicare would have denied
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or rejected or reached the out-of-pocket financial threshold, perhaps the secondary in that case
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would pick up. But it's important that you understand most secondary insurance for Medicare
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Part B is going to be a supplemental Medigap policy. You'll get paid without contracting
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But there is the occasional situation where it's a non-supplemental plan in the secondary position
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Guys, I hope that helps you. I hope that also gives you an idea of the kind of questions you guys can send in to me
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And I'm more than happy to answer them. All of these questions coming in are from my zero to paid Medicare billing group
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Actually, the course, if you want to learn more about that, you can find the description
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in the description of this video. Like this video, subscribe to the channel if you have it
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and keep searching the channel. I've answered hundreds of these questions. Your question probably has an answer
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somewhere in this channel. Guys, I'll catch you on the next video
