Medicare supplement policy FAQs
|Oct. 15 – Dec. 7, 2013
BCBSAZ’s Medicare supplement policies, commonly known as Medigap, offer our senior members added value and protection by paying some of the costs not covered by Medicare. Following are some of the most common questions we receive from providers regarding Medicare supplements and claims processing associated with these secondary policies.
1. If a provider opts out of Medicare, does a patient’s BCBSAZ Medicare supplement policy pay as primary?
No. If a provider has opted out of Medicare, there are no benefits available. This applies to all Medicare supplement policies.
2. What is the difference between a Senior Preferred policy and a Senior Security policy?
These plans differ in the access they give members to providers:
- Senior Preferred – Members must use Senior Preferred/BCBSAZ-contracted providers. Otherwise, there would be no benefits paid—unless services rendered were due to a medical emergency or accident.
- Senior Security – Members can see any Medicare participating provider, even if they are not contracted with BCBSAZ.
3. What Medicare supplement policies are currently offered by BCBSAZ?
BCBSAZ offers the following policies:
- Senior Security F, C, N, A
- Senior Preferred C, N
- Grandfathered plans (these plans are no longer sold, but we still have some members on them):
- Senior Preferred (Z4001)
- Senior Security (Z6001)
- Senior Security Plus (Z2001)
- Senior Security/Senior Preferred H
4. Do all the BCBSAZ Medicare supplement policies pay the Medicare Part B deductible?
Not all plans pay the Medicare Part B deductible for members:
- Senior Security A, N and H do not pay the Medicare Part B deductible. The Part B deductible is the patient’s responsibility.
- Senior Security (Z6001) and Senior Preferred (Z4001) pay 20 percent of the Medicare Part B deductible, while the patient is responsible for 80 percent.
5. What happens if Medicare denies medical services? Would the BCBSAZ policies pay as primary?
No. Our Medicare supplement policies follow Medicare guidelines; consequently, BCBSAZ will not pay as primary on Medicare-denied charges.
6. What happens if a member has a Medicare Advantage policy?
Our Medicare supplement policies do not coordinate with Medicare Advantage Plans. A person must have traditional Medicare in order to qualify for a Medicare supplement policy and have benefits available to them.
7. Is blood work covered at 100 percent by Medicare or a Medicare supplement policy?
Blood work is usually covered at 100 percent by Medicare or denied by Medicare. Rarely is there coinsurance applied to be paid by the Medicare supplement policies. Medicare-denied laboratory services would be the patient’s responsibility. NOTE: Pathology services are an exception to this rule.
8. Are routine physicals covered?
Medicare allows a one-time “Welcome to Medicare” routine physical. This physical must be completed within the first 12 months of the member becoming eligible for Medicare.
9. Is precertification needed for any procedure?
No. Since BCBSAZ follows Medicare guidelines, our Medicare supplement policies do not require any precertification. We will pay according to contract benefits, as long as the services provided have been allowed by Medicare.
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