Why Did I Get A Bill For An Endoscopy When I Have Medicare And A Supplment?

1. 

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   Jason Goldenzweig

   Co-Founder, TermInsuranceBrokers.com, Goldenzweig Financial Group, Las Vegas, Nevada

   Assuming you have both Medicare Part A and Part B (together this is known as "original Medicare"), these two parts pay for approximately 80% of diagnostic procedures. If you do not have a Medicare Supplement plan, then you may be responsible for the other 20% of the expense (if the doctor does not take "assignment" (meaning the doctor accepting the Medicare-approved amount as payment in full).
   
   If you had a Medicare Supplement plan, the 20% of expenses you would normally be responsible for may be fully covered, depending on which Medicare Supplement plan you have. There area 11 different Medicare Supplement plans available in the marketplace - plans F and G being the most comprehensive.
   
   Please note, if you do have a Medicare Supplement plan, when you visited the endoscopy center, both the Medicare ID card and Medicare Supplement ID card should have been presented to the receptionist (or whomever handles billing at the facility) so the facility could bill Medicare and then the insurance company for the difference (if you had a Medicare Supplement plan that was not a plan F, you may be responsible for an extra amount (to an extent - again, depending upon the plan letter you have)).
   
   I hope the information is helpful - please feel free to contact me if you have any other questions or would like to consider securing a Medicare Supplement plan. Even if you have a Medicare Supplement plan, a lower rate may be available to you without affecting the existing benefits or you may be able to improve upon what you have - Medicare Supplement plans are standardized so the coverage is the same for a given plan letter, regardless of the insurance company the coverage is through.

   Answered on January 11, 2016

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2. 

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   Steve Adlman

   Owner, Alabama Medicare Plans, Birmingham, Alabama

   For an endoscopy Medicare would only pay 80% not 100%. An endoscopy is a diagnostic test and is paid under Medicare Part B. If you had already met your yearly Part B deductible ($147 for 2015 or $166 for 2016) you should owe nothing for the test. Make sure the doctor who performed the endoscopy submitted a claim to your Medicare Supplement Plan.

   Answered on January 12, 2016

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3. 

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   Edward Crowe

   Owner, Crowe and Associates, Brookfield, CT

   It depends on which Medicare supplement plan you have. Many Medicare supplement have costs shares associates with them. A plan F covers 100% but other plans such as L or K only cover a percentage of what Medicare doesn't cover. You could also have a high deducible F plan which would not cover until the annual deductible has been met for the plan. Identifying which supplement you have will make it much easier to determine your coverage level

   Answered on February 12, 2016

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4. 

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   Joe 'Gravy' Graves

   Owner, I Hate Buying Insurance, Nashville TN

   Great question. As usual, not enough details to zero in on the exact reason WHY you received the bill. All the answers above are right.
   My questions/thoughts are:
   1. What Medigap plan do you have? F (which we almost never enroll clients in - MATH dictates that), G, K, N, or one of the other parts of the Alphabet soup.
   2. Was is just not billed or coded correctly?
   3. Depending on the supplement Letter you have, it could be that Excess Charges were not covered???
   4. OR... only an thought ... I get calls all the time from people who want to "look for a different supplement" when in fact they have a Medicare Advantage plan. The average person doesn't distinguish between the two: Medigap & Advantage. So if you have an advantage plan, you are getting billed for the co-pay(s).
   
   Reach out directly if you want further clarity. THANK YOU!!
   -gravy.

   Answered on February 13, 2016

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