Commercial Coverage paying Medicare rate

calexander1265

Networker
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43
Location
Raliegh North Carolina
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I am trying to confirm something I was told today by BC Federal. If a patient is over 65 and does not have Part B coverage, the patients commercial insurance, in this case Federal BC, is only required to reimburse at the Medicare rate. I remember hearing this years ago, and I thought it tied back to ERISA but can't locate any documentation to support this. Any input would be appreciated.
 
Messages
281
Location
Selden
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No official documentation to support this, but I do know in NY, the carrier that covers NY state employees (Empire Plan) will only reimburse what they would have paid if Medicare part B was in effect. The patient is responsible for the amount Medicare would have paid if patient had enrolled. I don't recall running into this issue with BC Federal.
FYI - my understanding of ERISA is that it is for private employers, and a federal employee would not be covered under ERISA.
 

michelleaapc2012

Guru
Local Chapter Officer
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105
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TN
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I agree, I have had BCBS Federal plans reimburse at Medicare rates for patients and when I call they say the same thing- This is the amount that Medicare would pay if the patient had Medicare. And ERISA can't help for Federal plans :(
 
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