Why Isn’t My Medicare Supplement Plan Paying Anything?
A long time client posed this question a few months ago. My quick response was . . .
Either you are really healthy, or you are really sick and Medicare is doing the heavy lifting. Above all else, DO NOT PAY BILLS until AFTER Medicare and your Medigap plan pays their portion.
The longer answer . . .
Over the course of a few months this lady had incurred over $300,000 in medical bills from two hospitalizations (unrelated conditions) plus several outpatient charges including surgery.
In her
words, Medicare paid a pittance and the same for my Medigap plan. Am I responsible for the balance?
In a word . . . no.
The claim process starts with Medicare. They review the
claim, approve eligible charges, discount the charges then pay their portion. You can review the claim totals in your MyMedicare account or wait on the MSN (Medicare Summary Notice) to arrive weeks later.
From there the claim goes to the Medigap carrier.
Medigap carriers are only responsible for claims approved by Medicare.
The patient is not responsible for claims denied by Medicare.
The MSN only tells part of the story. One hospital bill was $44,105 . . . the MSN says Medicare paid $2,291 and you (the patient) may be billed $898.
A second hospital bill was $20,965 . . . Medicare paid $527 . . . you may be billed $134.
The Medigap carrier paid $898 on one bill, $134 on the other. Patient responsibility $0.
At this point, the bills submitted to Medicare total over $65,000 and the patient owes $0.
More bills and MSN’s will follow but the pattern will be repeated and the patient will be responsible for nothing.
If she had a Medicare Advantage plan she could have easily owed $5,000 or more plus charges denied by the Advantage plan.