Hello, I have been on long term disability from my former large company which is all over the USA. Former company pays my cobra and offers me secondary health insurance.
In 2001, former company required that I apply to Social Security for Disability income and Medicare. I got approved? Is that allowed that Medicare be my primary insurance being that the company has thousands of employees?
The main thing that I am trying to figure out, is there, a standard rule or does my former company decide whether or not my secondary insurance company pays all of the cost of my medical visit if a provider either opts out of Medicare or does not accept assignment with medicare? Or am I responsible for the cost that the opt out provider charges?
My secondary always paid in full for my medical claims when Medicare denied due to an opt out provider based on fair and customary cost based on my zip code. All of a sudden my secondary is now saying no we do not cover the opt out providers cost. Who decides that rule?
I never can get a straight answer from them since each time I call something different is said. My former employer routes these kind of calls to the health insurance company.
Claim Codes: 5M* Medicare pays benefits before your group health plan. Since the patient used a provider who opted out of medicare, we processed this claim after estimating how much medicare parts a and/or b would have covered based on billed charges. The patient is responsible for the difference between the billed charge and the amount paid by this plan.
Who would be the correct decision maker on this issue? Is that true that no matter what my health insurance claims would never pay out more than Medicare's estimated amounts?
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