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Will Medicare pay the deductible amount if it is considered secondary?
Apr
21
2010
My mother is covered under my father’s insurance through work. She just was able to get Medicare within the past year. For some reason, Medicare is considered a secondary insurance to the insurance she has through dad’s work.
She was seen by a doctor not long ago and the majority of the doctor’s bill was put to her deductible. The doctor has now billed mom for the amount that was put to her deductible. It is a little over $200.
Shouldn’t Medicare pay that amount since it is mom’s secondary insurance? I really don’t understand why the doctor is billing mom and not Medicare. How can I check to see if Medicare would pay for this bill?
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Answer #1
Medicare is a secondary payer when a spouse is covered by a large employer group plan.
Medicare payment is considered based on what Medicare would have paid to the doctor. So if the insurance paid more than Medicare would have paid, then Medicare will not make payment. If the insurance pays less than Medicare would have paid, then Medicare will pick up the difference.
In your situation the best advise I can give you is to tell your mom to call the office and ask them if they accept Medicare. If the doctor does, than just provide the Medicare number and they will adjust those bills.
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