When you have Original Medicare and are admitted to the hospital, Medicare Part A is providing the coverage for that stay. Every hospital stay with Original Medicare has a deductible of $1484. Most individuals using Original Medicare also have secondary coverage, a retiree plan, or a Medicare Supplement Plan. Most Medicare Supplement Plans (also called Medigap Plans) pay the Part A deductible of $1484. The Medigap plans are labeled with letters, the most common plans being Plan C, F, G and N. All of these Medigap plans cover the Part A deductible in full. One Medigap Plan becoming popular is Medigap Plan K and this plan pays 50% of the Medicare Part A deductible.
When you have Original Medicare and a secondary coverage as well, the Hospital bill is processed by Medicare and then sent on to the secondary payer. This computerized Medicare processing of the hospital bill then sends the Medicare Summary Notice to the hospital and later sends one to you the individual. Once this determination is made by Medicare, hospitals bill the patient and simultaneously send to the secondary insurance for the Hospital Deductible ($1484). For most individuals with a Medicare Supplement Plan the secondary coverage will pay it, so they should not pay this bill.
Insurance companies don’t usually pay their bills as quickly as individuals. In a situation where you paid this $1484, your secondary insurance later pays the same amount, the hospital will process that second payment and within 4 to 6 weeks pay back the individual who had paid the amount previously.
I don’t recommend paying this $1484 bill that you received. I believe that you most likely have secondary insurance that will cover that bill in part or in full. I believe you should contact the hospital, reinforce that you have secondary coverage and give the hospital that information. The hospital may not have your secondary coverage in the system, so this phone call allows you the opportunity to give them that information. Once you know they have that information, you can rest easy knowing you don’t owe that amount.
I also recommend that you consider establishing a login on the www.medicare.gov website. This login would allow you to check your Medicare coverage and indicates that Medicare knows you have secondary insurance. The website allows you to review and print off your Medicare Summary Notices (MSN) for all your Medicare covered services very promptly. This allows you the opportunity to be sure the amount on the bill is correct. Medicare will send these MSNs to you quarterly, with all the Medicare Part A & B claims for that quarter.
Your secondary insurance will also process your claims and generate an Explanation of Benefits (EOB) that is sent to you. Most secondary insurance companies send them as they are processed, so they are not as delayed at the MSN’s. Your secondary insurance may also offer a website which allows you to create a login and then review and print off your EOB’s. This may be a useful tool in determining if you in fact owe this bill to the hospital. If you are not comfortable using a computer and the internet to look up this information, you can call your insurance company to ask these questions. Your secondary insurance card has a customer service number on the back of the card. Call that number to verify your coverage for this hospital stay. The customer service will review the dates of the hospital stay and probably be able to verify over the phone their coverage/payment for that stay. You can then request the EOB be sent to you now.
I am glad you are reviewing your mail and checking your medical bills before you pay them. Always check your medical bills against your EOB’s and MSN’s before you pay the bills sent to you by medical providers.