Primary Insurance Change, Late Filing, Unpaid Claims, Collections Threat

by Peter Q
(Brooklyn NY)

Since 2000 I have had medical insurance with GHI with no problem. In April 1st of 2011 I acquired Medicare due to my disability. Now I have two medical insurances (GHI and Medicare). At this time I was unaware that Medicare took over as my primary insurance.


In the end of the year 2012 my doctors sent my claims to GHI and GHI paid the claims. Then GHI realized that my primary insurance was Medicare. So they sent a collection notice to the doctors to reclaim the money. They also sent notice that they should re-file the claims with Medicare.

By the time they figured all this out Medicare is denying some of the claims due to late filing. Now my Doctor is threatening me with collections and adding interest - and ruining my credit. I just find it odd ... with two insurance coverages and no laps in insurance I'm being charged almost $2000. How Can I Fix This?

Thanx a bunch ,,,,,,,,,,,,,,, Peter Q

Response:

Peter,

What you’ve run into we see occasionally in billing for our providers - and it’s really not that uncommon.

Here’s how we handle it -

First the provider reimburses the payer that was mistakenly billed as primary - in your case this was GHI.

We then submit the claims to Medicare with an explanation that these claims were mistakenly submitted to the secondary payer who has since been reimbursed. In these situations we would file an appeal with Medicare which typically requires we submit additional proof such as the original Explanation of Benefit’s (EOB) and other documentation to clear up the late filing denial from Medicare.

Claims are then submitted to the secondary payer once the primary payer (Medicare) has paid on the claim(s).

Really the providers I’ve worked with don’t threaten their patients with collections. We just work it out between the payer as I described above and bill the patient for the amounts they are contractually responsible for.

Hopefully your doctor will not follow through with collection efforts. And really I don’t think that they would be very successful in doing so given you have adequate insurance coverage and have been cooperative in helping to figure all this out.

You also may want to talk to Medicare and describe the situation and find out exactly what your rights are.

Hope this helps answer your question.

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