Frequently Asked Questions

1. What is the current (2012) Medicare deductible for which the patient is responsible?
   Answer: $140.00
   
2. Will my secondary insurance carrier cover the Medicare deductible?
   Answer: It will depend upon your particular policy, some do, and some don't. You can call your secondary insurance carrier and ask.
   
3. When I need to have a test or procedure performed, whose responsibility is it to call my insurance company to see if pre-authorization/pre- certification is required?
   Answer: It is the responsibility of the ordering physician's office staff to call your insurance company as they are the ones ordering the tests/procedures. However, it is always a good idea to follow up with the office staff to be sure this was done. Lack of pre-authorization/pre- certification is responsible for many denials.
   
4. What is the difference between an HMO plan and a PPO plan?
   Answer: Generally speaking when you have an HMO plan you must see only in network physicians (participating in your plan) in order to receive full coverage. Often there will be a copay. When you have a PPO plan you usually can see out of network doctors, however, sometimes a deductible will apply and often only 70% of the bill will be covered by your plan. If you stay in network with a PPO, you should only be responsible for a copay.
   
5. Do I need a referral?
   Answer: Some plans do and others do not. It is beneficial to "know" your plan as if you present to a physician's office without a referral (when one is required) you could be responsible for the full amount of the visit, or be turned away, depending on the office policy.
   
6. If I have secondary insurance, will my doctor automatically file with my secondary carrier?
   Answer: While most offices do this, there a several that do not. It is always best to ask rather than just assume that this will be done.

Other Information:

If you have begun an appeal on your own with your insurance company there are three important things you must do. Keep a log —write down the date that you first placed the call. Ask for the name of the person with whom you are speaking, and most importantly, ask for a REFERENCE NUMBER for the phone call. Insurance companies punch these reference numbers into their computers as their "Bible". Without these numbers, the appeals process is much more difficult and time consuming. Keep an ongoing log for each and every encounter you have with them. Also if you have written to them, keep a copy of the letter for your own records.

Should you wish me to take on your case; all of the above information will be of great help to me and enable me to work through the "red tape" in a more timely manner.