Wiki Commercial Insurance, but Medicare Eligible

[ACTobias]

Has anyone heard of this new law for commercial insurance?....
Patient is of Medicare age has not elected to take Medicare, is still working, and has Commercial insurance. The insurance is only reimbursing at Medicare rate and not at our contracted rate, stating that there is a law now that they only have to reimburse at the Medicare rate if the patient is of Medicare age, even they have not elected to take Medicare.

 

[Herbie Lorona]

I haven't heard of a new law but I have seen this happen all the time. I will try to look into it the next time I run into one of these. My best suggestion would be first to see if the plan they actually have the pt enrolled in doesn't state that it is a Medicare Advantage Plan and second I would suggest to check with your provider rep to see what or if it is stated in your contract on something like this. This is not something new because I have seen them pay claims at the Medicare rate if the pt is Medicare age from years now. Hope this helps some.