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The primary is saying that charges exceed allowable for this procedure and Referral or prior authorization not obtained. They have also denied saying hospital/medical records missing. I know they have all the records, they were sent to insurance company via certified mail and signed for. There wasn't time for a referral, I was taken to hospital via ambulance and then surgery. The secondary keeps denying until primary makes a final decision.
No, this hospital is actually in-network. This is what happened - I had a Medicare Advantage plan for my insurance that we thought was primary. We didn't know that my husband's HHS thru his employer added me to his insurance by mistake. So, when I got hurt, I gave the hospital my Medicare Advantage card and was treated. I fell on Feb. 7, 2013, but we didn't find out about the other insurance until Feb. 25, 2013. This mistake made my husband's HMO my primary and my Medicare Advantage came my secondary. Once I found out that I was on his insurance by mistake, I had that corrected immediately, but the dates of service still fall under the HMO.
I spoke to Medicare, but they are saying that it's up to the insurance companies. Should I make more of an attempt to get the secondary insurance to pay the difference?