Medicare coverage runaround

[slgdev]

We have medicare and a supplemental (Option J).

If we go to our family doctor for a problem, it is definitely covered (100%). My question to medicare (even to the supervisor there) was simply this. Since my wife is currently in a rehab facility after a hip replacement, if I were to take her out in the morning to our family doctor, for the same problem that is 100% covered if she were not in a rehab, and I bring her back before midnight (not discharged), does the fact that she is in a rehab PRECLUDE payment to my family doctor?

All they would say is that "they cannot guarantee payment and it depends upon how the doctor submits the form". They completely stonewalled answering the specific question I asked, although I repeated it three or four times. Of course they apologized profusely for the inconvenience.

Does anyone know the answer to this?

 

[mattspits]

Not sure why you're asking this? As you stated, Medicare and the supplement plan J pays 100%. You would not owe anything to the doctor.

 

[slgdev]

Not sure why you're asking this? As you stated, Medicare and the supplement plan J pays 100%. You would not owe anything to the doctor.

As it turns out, I wouldn't be. Medicare will not cover an outside primary doctor if you have a primary in the rehab. Since they won't cover, that means the supplemental won't either and we would be liable for the whole thing. I got that answer today, not from Medicare, but from my primary's office who are experienced with these rules.

 

[mattspits]

Not sure why you're asking this? As you stated, Medicare and the supplement plan J pays 100%. You would not owe anything to the doctor.

As it turns out, I wouldn't be. Medicare will not cover an outside primary doctor if you have a primary in the rehab. Since they won't cover, that means the supplemental won't either and we would be liable for the whole thing. I got that answer today, not from Medicare, but from my primary's office who are experienced with these rules.

Correct, your supplemental only picks up what Medicare doesn't, and generally does not cover things that Medicare does not cover. I'm not an expert on when Medicare decides to pay or not based on certain scenarios. I'm glad you got your answer.