Rank: New Member
Joined: 10/4/2012(UTC)
Posts: 1
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If we are opted out of Medicare, can we submit medical claims to plans like Humana Gold Plus (which are contracted with the Medicare program)? And supplemental Medicare plans like those through BlueCross BlueShield?
We just wanted to be sure that what we were told by Humana (Gold Plus) provider relations was, in fact, true. We were told that we cannot ask for a Gap Exception because it is considered a Medicare plan for which we would be considered "opted-out" of.
Would plans like BlueCross BlueShield Medicare supplements be under the same guidelines, for which we shouldn't bother trying to submit?
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Rank: Administration
Joined: 11/21/2012(UTC)
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Hi ckperio!
If the patient's primary insurance is Medicare and you are opted out, unfortunately filing the claim to the secondary/supplmental insurance company will not work out, because you would need a processed EOB from the patient's primary insurance (Medicare), which you could not obtain without being a provider.
If the plan is a Medicare Advantage Plan - they generally have their own set of network providers that you could apply to (if you you wish) or request a gap exception/network deficiency to, even though you are not a Medicare provider!
Now - each of the Medicare Advantage plans "make their own rules" - so it is always best to contact the insurer before filing a claim to see if you must be a medicare provider to file with them, or if they have a set of provider you can join or seek a gap exception.
Hope this helps! Let us know if you have any further questions
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