Question about Medicare coverage

[kwall2004]

I have a question that my girlfriend and I have been unable to find an answer for, so I'm hoping that someone here has had some relevant experience with this.

She has recently passed the 3-year mark on peritoneal dialysis and this required her to make Medicare her primary insurance and to make her private policy (United Healthcare) her secondary insurance.  Up until this point, with UHC as her primary, UHC covered 90% of her regular doctor visits and Medicare, as her secondary, covered 100% of the remainder.  Now, Medicare, as her primary, pays whatever it is they agree to pay and UHC, as her secondary, pays 90% of the remainder.  This remaining 10% leaves her with a rather sizable bill each month.

She's talked to UHC about this and the person she talked to said they pay 90% regardless of whether they are the primary or not.  This doesn't make sense to us.  Do any of you know anything about this kind of situation?

[boxman55]

I have medicare as my primary and it covers 80% and then I have AARP United Health Care as my secondary and they cover the 20% as the medigap insurance don't know why you only get 10% ...Boxman

[BigSky]

If  someone takes Medicare they have to accept the Medicare approved charge.  Of that charge Medicare pays 80% and the 20% that is left is owed by the patient or their insurance company.   From what you say it seems UHC only pays 90% of any charges, whether they are primary or if they are secondary.  So they are only paying 90% of the 20% copayment that medicare doesnt cover.   She might check into UHC and see if there is a different plan where they will cover the entire 20% copayment Medicare doesnt pick up.

[flip]

A few observations:

Many insurance companies only pay up to the Medicare approved amount.

Many dialysis centers accept insurance payments as Payment In Full. Others gouge for every dime they can get.

Most policies have a maximum out-of-pocket expense and/or annual deductible.


I still have UHC as primary and I've never paid a dime.