I need help understanding Medicare as primary payer!!

I am going on Medicare A in December.  I have decided to temporarily opt out of Medicare B and will remain covered under the BCBSNC  PPO plan that my husband gets through his business, at least until after my surgery.   This is where I get very unsure, and would appreciate word from someone who has been in this same situation or someone who files insurance for a living.

I understand that Medicare A will become my primary payer and BCBS will become secondary (husband's office is small).   I want to have a VSG, which Medicare will not cover at all, but BCBS will.  So, Medicare is obviously going to reject payment to the doctor and hospital for the VSG, but my question is, what will BCBS then do??  Is there ANY chance that BCBS will not pay for the VSG on the basis that my primary coverage has refused it??  Do the payment rules change for something like the VSG, when BCBS becomes the secondary payer instead of the primary??

I guess to someone who knows better, this may seem like a stupid question to worry about, but I have enough trouble trying to understand BCBS by itself!!  Adding Medicare into the mix is about to make me lose my mind worrying.  I would most definitely appreciate any words of wisdom anyone might have on the subject!!

Thanks so much!
Cathy

Cathy,

You need to get pre-authorization from BCBS, even though they are secondary. Make sure this is done before you have your surgery. Inform your Bariatric surgeons office that you have secondary insurance. You don't want to get too far into this process without following the pre-op guidelines for both insurances. Your bills need to sent to Medicare (primary insurance) first. When your denial comes from Medicare, the bills, along with the explanation from Medicare which will show that they didn't pay, need to be sent to BCBS. BCBS will see that your primary insurance didn't pay before they pay anything. Then they should pay the bill as if you only have BCBS for insurance. I hope this helps. Good Luck!

Pallas

Double check that you are ALLOWED by your employer's insurance to decline Part B.  We actually did the same thing you are planning (declining Part B because of our BC/BS)  for my DH and later found out that we were REQUIRED to carry it according to our employer's benefit package.  Fortunately, we found out five months later, but within the six month "window" you have to pick up Part B without penalty.  He actually had to postpone a surgery he had scheduled until 3 months later because of our error.  It coulda been a LOT worse...he might have had the surgery and THEN we could have found out we weren't covered.....that would have REALLY been a mess.  You know that Part A is ONLY hospitalization, not doctors, right?

Wouldn't hurt to check and make sure.  I did not even think to ask.

Good luck to you.

First of all Cathy Medicare A is for the hospital part only so you could possibly have a denial from them for even the hospital bill,  then it would go to BCBS but you will need to have the surgeons office get predetermination approval for the surgery