Why Aren’t All My Medicare Claims Forwarded To My Secondary?

Not everyone understands the billing process of the medical industry. It’s filled with claims, medical jargon and a unique coding system. However that doesn’t mean Medicare members have to suffer for it. The medical industry uses Medicare as the primary billing source. So those with secondary insurance shouldn’t expect to be treated any differently. This is done for many reasons, up to and including business sense.

Secondary Payment Act

Medicare is used as the primarily billing source, because it is seen as reliable. Medical organizations are faster to respond then conventional accounts, which still may require collection. Reimbursement includes doctor care, tests and medication treatments. In the event secondary insurances exist, they are typically billed after, if it applies. In the event this role is reversed, Medicare expects primary insurances to cover the payment. This is in accordance to the secondary payment act, which curtails cost for the nationwide program. This is used whenever patients attempt to use Medicare as their secondary insurance.

Primary Insurance Definition

When Medicare is used as the secondary insurance, the primary insurance has to legally communicate with Medicare prior to taking on their benefit recipient. The expectation is simple; the primary insurance can’t knowingly take a member and divert costs at the same time. As a result, this is why it is often treated as the primary biller and record recipient. Claims will not be forwarded to a secondary, because the responsibility is considered the others responsibility. Only when the billing is reversed is this considered. That is why Medicare rarely sends claims to a secondary. One of the only exceptions is when reimbursement is denied in the primary and left for the secondary insurance to pay. Members must decide how their insurance programs stack against one another.

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