anyone w/knowledge of Medicare???

[abevilac]

My parents are 90 and 92 and have been in very good health, but now my Dad has a skin cancer that required some surgery and now follow-up radiation. They are starting to get bills from the hospital and I happen to be visiting and I saw that one bill said that "our records show that you have one insurance plan. If you have coverage with any other plan, please contact us."

So, the have Medicare and a supplemental insurance called KHPE. When they go to the hospital, they have only shown the KHPE card and never the Medicare card.

I am wondering if the hospital has ever submitted anything to Medicare??? Wouldn't they need the info on the cards? I find it odd that they have never been asked for the Medicare card. Does anyone have a clue?

Thanks.

[markmedic]

Usually the hospitals have Medicare automatically entered on the form once they have been visiting a hospital for more than a few years. It is worth a call to make sure they are being credited with a Medicare but usually if you have a supplemental they won't pick up until after Medicare has been charged.

[mrlynn]

Are they getting EOBs from both plans? You should call the hospital billing office and make sure they have both plans on file, with up-to-date numbers. Don't let them pay any bills until both carriers have paid.

/Mr Lynn

[abevilac]

They are not getting any paperwork from Medicare at all which is why I think something is weird.

[Fred_Also]

I am on Medicare but I have a plan through my former employer. I have a Highmark Blue Cross Blue Shield card issued by Highmark. The former employer pays part of the premium & I pay the rest (deducted from my retirement check). Medicare also deducts monthly from my SS check.

I never have to deal with Medicare. I never show my Medicare card, only the BC/BS card. Highmark takes care of it all and I never get an EOB from Medicare, only from Highmark. Sure cuts down on my paperwork.

There are some weird plans out there.

I had one Dr. office that was determined to see my Medicare card & they filed on both. It took me 6 months to get that straightened out.

Fred

[Fritz]

there should be EOBs as Mr Lynn said.
Sounds like someone at the hospital didn't do their job.

[michaelb]

I think the first step is determining what coverage they do have. the KHPE could very well be a Medicare Managed Care plan, aka Part C, so they could have "one insurance" plan. they should also have a Part D plan, for prescription drug coverage. So they may have 1, 2, 3 or more different Medicare related coverages.

Medicare "supplemental" insurance is a very specific meaning, and is sold as an alphabet soup of standardized plans. Each letter plan has different coverage, but the overall coverage is limited (to what is generally known as the cost sharing aspects of traditional medicare.

Medicare Managed Care, Part C, changes all of this, and by signing up for a private for profit managed care, they will get a different benefit package, and may have different cost sharing or benefit limits.

The 2nd step is determining whether Medicare is actually covering this care, or not, and if the bills are for "cost sharing" for medicare, or not. The EOB for Medicare is known as an ABN (advanced beneficiary notice) so the hospital should have provided that.

[mrlynn]

What MichaelB said. I was assuming that by 'supplemental' you meant 'supplemental', like BCBS Medex. But, come to think of it, I don't recall any others except one from United Healthcare, at least here in Massachusetts. If this KHPE is a Medicare Advantage plan, then they would get only one bill and EOB. Best to have a look at their cards, and if necessary, call the carriers—and then the hospital, if there's still a question.

/Mr Lynn

[abevilac]

thanks all for the comments. I will call all of the parties and figure out what's going on.

[AllGold]

Yep, a lot of people call anything and everything a "supplement" or "Medicare supplement" when it is not.

An actual Medicare supplement is a standardized plan with a letter like a 'Plan F' or 'Plan D'. That is probably not what they have since you must also present your red, white and blue Medicare card along with the insurance card. Medicare is actually the primary payor and the Medicare Supplement insurance supplements what Medicare does not pay.

They either have a Medicare Advantage plan or an employer group plan (which may or may not be a Medicare group plan).