Our physician is out of network with all private payors except for Medicare. We have a patient who has a private insurance and Medicare as secondary. After the primary pays, the balance goes to Medicare, but Medicare will only cover a portion...does that get written off?
No, it become the patient's responsibily. You also have to check if the patient has both medicare A & B. And make sure that it's not a medicare opt out program, in which the patient waives all their medicare benefits, and signs them over to an outside insurance carrier. Mcr is only secondary if the patient or spouse is working full time. I'd also see if there is any out of network benefits for the primary insuarnce, unless it's an HMO there should be. hope this helps.
Generally any secondary insurance including Medicare will only pay based on approved charges. If the doctor is out of network, the charges will probably be more than the insurance company will approve and there will be excess charges even if Medicare does pay some of the bill. The balance will be billed to the patient.
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