Travel Ins and Med Supp

[vic120]

Just because a person has a supplement policy doesn't mean she has to file a claim on it. There's nothing in the rule book that says she has to.

Like I said the other day, she doesn't need to sign anything now. Not until you've had a chance to run it by UHC or a knowledgeable travel insurance agent.

Based on what you just posted, it seems that Arch is simply on a fishing expedition. I certainly wouldn't blink.

And then this

But it all seems to put my head in knots, not sure what it is saying

Its been a long day I might need to read it a few times
But IF their Supplement is secondary to Medicare does that not exempt it from this?

I don't know I will need to read a few more times

"This Plan" is the parts of this blanket contract that provide benefits for health care expenses on an expense incurred
basis.
"Primary Plan" is one whose benefits for a person's health care coverage must be determined without taking the existence
of any other Plan into consideration. A Plan is a Primary Plan if either:
(a) the Plan either has no order of benefit determination rules, or it has rules which differ from those in the contract; or
(b) all Plans that cover the person use the same order of benefits determination rules as in this contract, and under those
rules the Plan determines its benefits first.
"Secondary Plan" is one that is not a Primary Plan. If a person is covered by more than one Secondary Plan, the order of
benefit determination rules of this contract decide the order in which their benefits are determined in relation to each other.
The benefits of each Secondary Plan may take into consideration the benefits of the Primary Plan or Plans and the benefits
of any other Plan, which, under the rules of this contract, has its benefits, determined before those of that Secondary Plan.

 

[rmhaire]

But it all seems to put my head in knots, not sure what it is saying

Standard insurance gobbly goop. And that's why God created lawyers.

I still say run it by UHC. They've dealt with it before and pretty sure they've dealt with Arch.

 

[vic120]

Standard insurance gobbly goop. And that's why God created lawyers.

I still say run it by UHC. They've dealt with it before and pretty sure they've dealt with Arch.

Good Idea

 

[somarco]

IF their Supplement is secondary to Medicare does that not exempt it from this?

Medicare is not involved in this situation. Medicare is only good in the US and territories.

The referenced diatribe about primary and secondary coverage is word salad.

 

[vic120]

Medicare is not involved in this situation. Medicare is only good in the US and territories.

The referenced diatribe about primary and secondary coverage is word salad.

Yea I cant make heads or tails of it I read it like 100 times

Medicare I agree, but UHC is the supplement. and does have travail coverage is what they are saying I am thinking

 

[vic120]

Medicare is not involved in this situation. Medicare is only good in the US and territories.

The referenced diatribe about primary and secondary coverage is word salad.

Ok she just forwarded me the email they sent her I don't have time to read till maybe tomorrow night actually

But it opens with, I read the rest tom night there are kike 5 attachements

Please be advised that as the Claims Department has closed your claim. Your claim is now with the Subrogation/Recovery Department to attempt to coordinate benefits with your primary health insurance carriers, Medicare and AARP/United HealthCare (Medicare Supplement Policy).

Coordination of Benefits is being pursued as you held multiple primary policies, in accordance with your policy. In order to do this your assistance is needed and we would like you to provide you with some information about the process.

Steps required in the Coordination of Benefits Process:

Steps required in the Coordination of Benefits Process:

1- Medicare requires the attached Request For Medical Payment claim form be submitted with our support packet, and they also require a HIPAA Authorization form be on file with them, for us to be able to follow up on claim status of the claim we submit.
-- We ask that you submit the HIPAA Authorization to Medicare in order for us to follow up on the status of the claim we will submit related to payments we have made.

 

[kak6407]

Ok she just forwarded me the email they sent her I don't have time to read till maybe tomorrow night actually

But it opens with, I read the rest tom night there are kike 5 attachements

not sure what I would do here. But it seems to me based on that email they are wanting to submit the claim to Medicare, which of course Medicare will deny because it is out of the country.

Does Medicare then send it to UHC for payment? That is the question. Even if they did I don't think she would be liable for anything because UHC would pay their share leaving the $250 deuductible and the 20%. If she had no deductible on her plan or already paid it (and it was over $250) with 100% coverage then I think the travel policy would show as paying the $250 deductible and the 20%.

Interesting scenario and one that I think we are all learning from your situation. Keep us posted on this outcome.

 

[vic120]

not sure what I would do here. But it seems to me based on that email they are wanting to submit the claim to Medicare, which of course Medicare will deny because it is out of the country.

Does Medicare then send it to UHC for payment? That is the question. Even if they did I don't think she would be liable for anything because UHC would pay their share leaving the $250 deuductible and the 20%. If she had no deductible on her plan or already paid it (and it was over $250) with 100% coverage then I think the travel policy would show as paying the $250 deductible and the 20%.

Interesting scenario and one that I think we are all learning from your situation. Keep us posted on this outcome.

Here is the thing it is a long time client since 2012 she has moved from UHC to BC and now back to UHC med supp in Ny she also refers to me clients

So I dont want to mess her up

 

[somarco]

I have never heard of a travel med plan subrogating a claim to another carrier. This is a real first for me and it gives me the impression they are looking for ways to piss folks off.

Over the last 20+ years I have represented a handful of travel med carriers and this type of thing seems unprofessional.

If you are the agent who placed the travel plan you need to do what you can to fascillitate this process and then never use them again.

 

[vic120]

I have never heard of a travel med plan subrogating a claim to another carrier. This is a real first for me and it gives me the impression they are looking for ways to piss folks off.

Over the last 20+ years I have represented a handful of travel med carriers and this type of thing seems unprofessional.

If you are the agent who placed the travel plan you need to do what you can to fascillitate this process and then never use them again.

NO I sold the supplement only advised her to get a travel policy