Private Health Ins. Co. won't pay bill before submitted to Medicaid B. But don't have Medicaid part B

Question

Can a private health ins. company, (Blue Cross, Blue Shield) refuse to pay a bill for retired elderly. Rational being Medicaid B will pay bill, but retired elderly isn't enrolled in Medicaid part B because he has Blue Cross Blue shield.

Answer 1

Its possible.

I know, for example, that the Public Employees Retirement System for the state of Ohio requires that all retirees take Part B if they are eligible.  If a retired person chooses not to enroll in Part B, the retirement fund will not pay for the charges either.

I saw a retired lady get stuck with a $20K bill because she decided to drop Part B and never discussed it with the retirement fund.  (Her own fault, because Ohio retirees are well notified about the Medicare requirement.  But still sad for her.)

Anyhow, sure...its possible that a retirement plan can require that retirees enroll in Medicare Part B.  The retirement plans aren't set up to be primary coverage for retirees who are Medicare eligible.

Answer 2

Yes, they can.  They will always be a SECONDARY insurer, not the primary insurer.  If the person elected to have no primary coverage, such as Medicare part B, then the secondary insurer doesn't necessarily have to pay.  

The plans do vary, so they should talk to their private health insurer to see how it was set up.

Answer 3

Just submit the bill to get the rejection, then the company will pay.  I had this same problem with Medicaid and my insurance.  Sometimes they just need proof (rejection letter) to do what they are supposed to do.

Answer 4

Insurance companies are not liable to pay for stuff that other people are legally liable for. Sounds like the insurance co. is trying to claim that the person had Medicaid B. You may need an atty. (pay him hourly) or someone but it's cheaper for the Private Helath Care Co. to claim someone else owes the payment and not pay it. You need to force their hand!

Answer 5

I believe you are talking about Medicare Part B, not Medicaid. Private health insurance for anyone over 65 is secondary to Medicare unless you are working and on a group plan with more than 20 lives. You must sign up with Medicare within 8 months from the date you stop working or you will have penalties and time restrictions to get on Part B.

If it has been less than 8 months you can still apply for Part B, if it's been longer you can apply from January 1 to March 31 for a July 1 effective date. If you are eligible for Medicare and do not have it the private insurance (it doesn't matter which company) will not pay.