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Month: November 2016

MEDICARE: TRUE SECONDARY PAYERS VS. SUPPLEMENTAL INSURANCE IN THE CHIROPRACTIC WORLD

If you have Medicare as your primary insurance, and other health insurance or coverage, or what is called a “true secondary,” each type of coverage is called a “payer.” The “primary payer,” in this case Medicare, pays what it covers on your bills first, and then sends the rest to the “secondary payer” for payment. In some cases, there may also be a third payer as well.

Medicare pays up to the limits of its coverage. For example, with chiropractic coverage, Medicare will only pay for billing that contains certain manipulation codes.  Exams or anything that falls under physical therapy is not a covered benefit when performed by a chiropractor.

Medicare in most cases will then submit its “Explanation of Benefits” (EOB) to the secondary payer. This is what is called a cross-over.   Although it should, this is doesn’t always happen this way.  There are instances where the billing department will have to wait to receive the EOB from Medicare, and then submit a paper claim to the secondary payer. The secondary payer will then pick up uncovered costs.  This is only if you have what is called a “true secondary.”  It is important to note that this coverage is very different from supplemental insurance.

If your secondary payer is “supplemental insurance,” it will only pick up what Medicare covers as this type of insurance policy follows standard Medicare guidelines. All other services will be denied.

So to avoid denials of coverage after services have been provided, your best course of action is to verify your coverage with both insurance companies before starting any treatment plan!