I'm covered by Medicare as my secondary insurance. The primary insurance is commercial insurance that I have through my job.
I saw a doctor, who charged $250 for the visit. My primary insurance, the commercial plan, accepted $150 of the $250 as being the "reasonable and customary charge" and, according to the plan rules, they paid 70% of the $150 that they accepted, or $105.
The claim was then submitted to Medicare, as the secondary. The Medicare Approved Amount for the claim was $80.28. After applying the part of the deductible that was still outstanding for the year, Medicare paid $27.77. The statement from Medicare says that the maximum that I can be billed is $51.94. (I can't quite figure out the arithmetic on this: I would have assumed that the max I can be billed is $80.28 minus $27.77, or $52.51. I don't know where the $51.94 comes from.)
Question is: how much can the doctor bill me, after accounting for both of the insurance payments? Here are the possibilities, as I see them:
1) The doctor billed $250 and has received $105 from the primary and $27.77 from Medicare, so he can bill me the difference, or $117.23.
2) Medicare says that the most he can bill me is $51.94, so he can bill me that amount.
3) If the only insurance I had were Medicare, the doc would receive a maximum amount of $80.28. Given that he has already received $132.77 between the 2 insurance payments, I should owe zero.
Anyone able to give a definitive answer to this?
Thanks.
I saw a doctor, who charged $250 for the visit. My primary insurance, the commercial plan, accepted $150 of the $250 as being the "reasonable and customary charge" and, according to the plan rules, they paid 70% of the $150 that they accepted, or $105.
The claim was then submitted to Medicare, as the secondary. The Medicare Approved Amount for the claim was $80.28. After applying the part of the deductible that was still outstanding for the year, Medicare paid $27.77. The statement from Medicare says that the maximum that I can be billed is $51.94. (I can't quite figure out the arithmetic on this: I would have assumed that the max I can be billed is $80.28 minus $27.77, or $52.51. I don't know where the $51.94 comes from.)
Question is: how much can the doctor bill me, after accounting for both of the insurance payments? Here are the possibilities, as I see them:
1) The doctor billed $250 and has received $105 from the primary and $27.77 from Medicare, so he can bill me the difference, or $117.23.
2) Medicare says that the most he can bill me is $51.94, so he can bill me that amount.
3) If the only insurance I had were Medicare, the doc would receive a maximum amount of $80.28. Given that he has already received $132.77 between the 2 insurance payments, I should owe zero.
Anyone able to give a definitive answer to this?
Thanks.
