I have large group insurance through my husband’s work, so they’re primary. Picked up Medicare Part B when it became available to me, I’m disabled, they’re secondary.
I had a 12,000 claim for some scans earlier this year, and I’m having extreme difficulty figuring out how this claim paid the way it did on Medicare’s side. (I used to pay commercial claims including some where Medicare was primary but no experience with Medicare as secondary, and I am REALLY CONFUSED. I have attached the commercial payment info, and a summary of the Medicare info (I could not get that to not take multiple pages. Can try to post the rest of it if you really need it.)
Note: I had not hit my deductible so of the Medicare responsibility, $203 of it was that. The rest was coinsurance, but I am really stuck trying to figure out how they came up w/ that coinsurance.
Further, I think, depending on how my claims are going to be calculated, I may be wasting my money having part B at all; but I don’t want to pull the plug on it if I am wrong.
Commercial benefit for my most common services is 10% coinsurance. Medicare is, well, original Medicare at 20% coinsurance after the deductuble.
Payment info on this claim from both. https://imgur.com/a/qvGDLye
submitted by /u/KamateKaora
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I have large group insurance through my husband’s work, so they’re primary. Picked up Medicare Part B when it became available to me, I’m disabled, they’re secondary. I had a 12,000 claim for some scans earlier this year, and I’m having extreme difficulty figuring out how this claim paid the way it did on Medicare’s side. (I used to pay commercial claims including some where Medicare was primary but no experience with Medicare as secondary, and I am REALLY CONFUSED. I have attached the commercial payment info, and a summary of the Medicare info (I could not get that to not take multiple pages. Can try to post the rest of it if you really need it.) Note: I had not hit my deductible so of the Medicare responsibility, $203 of it was that. The rest was coinsurance, but I am really stuck trying to figure out how they came up w/ that coinsurance. Further, I think, depending on how my claims are going to be calculated, I may be wasting my money having part B at all; but I don’t want to pull the plug on it if I am wrong. Commercial benefit for my most common services is 10% coinsurance. Medicare is, well, original Medicare at 20% coinsurance after the deductuble. Payment info on this claim from both. https://imgur.com/a/qvGDLye
submitted by /u/KamateKaora [link] [comments]Read Morer/HealthInsurance