DL HEALTH CLAIM SOLUTIONS, LLC - Your Medical Bill Advocate
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Medicare/Secondary Insurance

This post is for people with Medicare and a secondary insurance that is NOT a Medigap policy. 
 
 Did you know that if you have medical services that are not covered by Medicare, but ARE covered by your secondary insurance, there is a certain way you must submit your bills to the insurance? Suppose your doctor is opted out of Medicare, so you have to pay him up front and he gives you a statement to submit yourself. You MUST complete a 1490S form, found on the Medicare website. Attach copies of the bills from your provider to this form. Write in big bold letters: FOR DENIAL ONLY across the top of the form. Mail it to Medicare so that they will create a Summary of Benefits for this service denying payment. Then you must take a copy of that summary from Medicare, a copy of the bill, and your secondary insurance claim form, and send it in to the secondary insurance.
 
If you do not first send it in to Medicare, your secondary insurance will either deny payment outright stating you must first bill Medicare, or they will pay against some arbitrary number they have dreamed up as the amount Medicare would have paid.
 
This whole process sounds complicated, but it is really about being organized and keeping copies of everything.