| Subject | Date Asked | Expert |
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| Coordination for Benefits for past 5 years. | 7/8/2009 | Adelaide Rose |
Q: My daughter, age 27, is disabled. Her Dad carries her on his Federal BC/BS policy and she has ...
A: Betsy, Depending on the state, the limitations to be able to go back are different. Most states ...
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| General question on EOB and claims submissions | 7/7/2009 | LASHUNDA |
Q: My question is the following – I have an individual PPO health insurance plan with Blue Cross Blue ...
A: I'm not quite sure why the insurance company is stating that the eob is a legal document. I guess I ...
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| back surgery denial | 7/6/2009 | Tricia |
Q: i have ddd with mass nerve impingement at l5 s1 vert.in april of 09 my surgeon and i decide that ...
A: Usually insurance companies have to pay for procedures that are deemed medically necessary.....so if ...
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| Pre Existing Arthritis and Jaw Problem. Insurance Coverage? | 7/4/2009 | Tricia |
Q: Ive had an arthritis problem since age 12, I am 21 now. It is a type of psoriatic arthritis called ...
A: It is impossible for me to tell you which insurance company would cover this type of surgery since ...
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| Line item on EOB for a hospital claim | 7/4/2009 | Tricia |
Q: Your answers and suggestions are great. Thank you in advance for your help. My question is the ...
A: Usually if a service/item is considered non covered the patient is liable, however if your local ...
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| Out of network benefits for prenatal care. | 7/1/2009 | Tricia |
Q: I am currently 7 months pregnant, and I am using my out of network benefits to cover the costs. My ...
A: If your out of network benefits is 70/30 then you probably will receive a bill for your portion as ...
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| Cobra to SSD | 7/1/2009 | John Pedit |
Q: again John. I have followed all your advice so far. My husband chose only Part A and went on his ...
A: By all means apply for SSD. But now it becomes difficult to advise. You are pretty well set up as ...
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| Medical records | 7/1/2009 | LASHUNDA |
Q: How long must a specialty office keep patient reocords? Dermatology and plastic surgery office. This ...
A: I have no idea what the federal regulations are or even if there are what they would be. I do know ...
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| Michigan - Can a chiropractor charge a 100% markup if not paying with cash? | 6/30/2009 | Tricia |
Q: I went to Long Chiropractic Center in Brighton, MI. I now find out that by paying through insurance ...
A: Most providers/Dr's have a set price (UCR) for those with insurance and then a prepay price if ...
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| denial of payment by HIP | 6/29/2009 | Merry Schiff |
Q: My family lives in NYC, my mom is 70, she and my Dad were in Atlantic City, NJ for a few days, in a ...
A: Your mom evidently has Medicare but she is part of a Medicare Advantage Program which is part of ...
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| medicare | 6/27/2009 | Merry Schiff |
Q: I am 59 and retired two years ago. I will receive my health benefits until I am age 62. Upon age 62 ...
A: All of this depends on the amount of employees at your company (Really!!) and please do not confuse ...
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| Secure Horizon | 6/26/2009 | Merry Schiff |
Q: Moms has a HMO and is married to my father who is in very good health. They were both living with me ...
A: If the HMO that your mom has is also doing business in Sacramento then all you have to do is ...
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| Collection money from medicare pts | 6/25/2009 | Adelaide Rose |
Q: When a patient comes in for a visit, is it illegal to collect the coinsurance or deductable for that ...
A: Terri, Assuming that you are an in-network provider, you may not collect any of the patient's ...
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| Age 65, Still Working SS and Medicare question | 6/25/2009 | John Pedit |
Q: My mom turns 65 this year and still wants to work. She has Health Insurance at her job. She is ...
A: She sure can Go to the SSA office a couple of months before her birthday and apply for Medicare. ...
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| Medicare claim - grandmother | 6/25/2009 | LASHUNDA |
Q: My grandmother fell at my mom's home several months ago (she doesn't live there). As a result of ...
A: Medicare will not take responsibility for a claim in what's called a "no fault" accident. The ...
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| elderly patient, broken hip | 6/24/2009 | John Pedit |
Q: Before falling at the end of April and breaking a leg just below the hip joint, my 90-year-old ...
A: Locate the Area Agency on Aging that covers your area. They have many programs and services that ...
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| Medical coverage. | 6/24/2009 | LASHUNDA |
Q: What is the exact meaning of pre-existing Clause?
A: A pre-existing clause in a health insurance policy is a medical Condition that existed before a ...
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| opting out of medicare part b | 6/23/2009 | LASHUNDA |
Q: I have a patient who is working, so he opted out of his part B benefits. Now Aetna says that since ...
A: He can certainly file a letter of good cause and pay his back premiums (which about 1100.00) with ...
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| Medical Records | 6/23/2009 | Adelaide Rose |
Q: How long must a physicians office keep records on site for patients. that have not been seen. We ...
A: The charts don't have to be kept in house, however, the charts must be easily accessible in the ...
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| opting out of medicare part b | 6/23/2009 | LASHUNDA |
Q: I have a patient who is working, so he opted out of his part B benefits. Now Aetna says that since ...
A: Most all plans require a person to take medicare when eligible. The requirement for a person to ...
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| Collections | 6/23/2009 | LASHUNDA |
Q: OKay, so I am stressed to the max. I was seen by the foot doctor 2/3/07. On June 15, 2009 I was ...
A: I'm not sure how it works. They may very well go after the physician office because they are not ...
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| reply to your questions | 6/22/2009 | John Pedit |
Q: John, I asked my original question a few days ago and you replied with a list of questions. I sent ...
A: Been running between doctors for the last two days. Still a little shaky. For Him: he will have ...
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| Medicare coverage | 6/22/2009 | John Pedit |
Q: I am 67& receive SS and medicare A & B benefits as primary and personal insurance as secondary ...
A: With Medicare it is pretty limited. From US mainland: emergency when traveling in a direct course ...
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| Collections | 6/22/2009 | LASHUNDA |
Q: OKay, so I am stressed to the max. I was seen by the foot doctor 2/3/07. On June 15, 2009 I was ...
A: Mail the collection agency a copy of your Medicaid card and tell them that's who they should bill. ...
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| Cobra/Medicare/leave of absence | 6/20/2009 | John Pedit |
Q: John: I wrote to you last year but my situation has recently changed. I am on medical leave from ...
A: Boy, you do not ask easy ones. Off hand it would appear that I would recommend both going on his ...
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| billing | 6/20/2009 | LASHUNDA |
Q: I do medical billing for an office that see patient of all ages and all insurance. we are trying to ...
A: If all that you do is the billing for that office and not the actual front office work. Then the ...
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| medi-medi patients | 6/19/2009 | LASHUNDA |
Q: I have a Medi-medi patient in California treating with a chiropractor. I have never billed before ...
A: I don't know anything about Medi-Medi in California. How it works in Texas is the Medicare ...
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| insurance won't pay | 6/18/2009 | Tricia |
Q: I recieved a referal from my primary Dr. to go see A heart specialist also in network. Insurance ...
A: Depends on the explanation of benefits that you got from your insurance carrier when they denied. ...
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| Transferring state to state | 6/18/2009 | John Pedit |
Q: I am moving to texas and wondering if I can transfer my medicaid down there and how i go about doing ...
A: Because each State receives federal money for part of their Program and uses State money for it, ...
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| medicare/medicaid | 6/18/2009 | LASHUNDA |
Q: If a patient has medicare covered services only thru the medicaid program and medicaid does not pay ...
A: If your physicians agree to accept Medicaid as payment in full then you should watch the R&S ...
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| Medicaid and Inheritance | 6/16/2009 | John Pedit |
Q: My sister is disabled and has been on Medicaid for many years. She is due to receive an inheritance ...
A: Ohio has one of the best systems in the US. So check with the case worker. The accountable assets ...
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| COORDINATION OF BENEFITS | 6/16/2009 | LASHUNDA |
Q: We billed a claim to patient Primary Payer and claim came back denied because the provider was ...
A: You should always bill all insurances available. As a fact, Medicare requires you to bill them for ...
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| transferring Medicaid | 6/16/2009 | John Pedit |
Q: I have a friend at church who has decided to move to Kentucky from Indiana and has asked me what ...
A: Each State has separate funding and regulations. so basically you can not transfer Medicaid from ...
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| Medicaid and Inheritance | 6/16/2009 | John Pedit |
Q: My sister is disabled and has been on Medicaid for many years. She is due to receive an inheritance ...
A: Hard to answer because the Medicaid and the Recovery regulations vary from State to State. However: ...
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| weight loss surgery in NJ | 6/16/2009 | LASHUNDA |
Q: I have Health net Family Options through my medicaid. For about 11 years I have struggled with my ...
A: My profile for allexperts.com states that I am only familiar with Texas. I can barely tell you ...
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| Preventative medical care claim | 6/16/2009 | Merry Schiff |
Q: I have a health savings account high deductible medical plan that says it covers 100% of the cost of ...
A: It does not sound to me that this is preventative. I do not understad why it wasn't covered with the ...
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| HMO nightmare | 6/15/2009 | LASHUNDA |
Q: We are seeing more and more of our home health patients switch from either straight Medicare to HMO ...
A: I think we are all experiencing changes in healthcare. From you question, I'm not sure if you guys ...
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| Secure Horizon/Medicare billing questions | 6/15/2009 | Tricia |
Q: My mother switched last Dec. to Secure Horizon's Complete Plan 1 and we have had nothing but ...
A: Sometimes AARP has local centers that can help Medicare patients. Check their site to see if they ...
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| International claim denied | 6/13/2009 | LASHUNDA |
Q: I was hospitalized in Ireland during a vacation 5/25/07-5/31/07. Before my trip I had checked with ...
A: I don't want to seem as if I'm taking up for the providers but BCBS can be a little tricky to bill. ...
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| Help with Medicare Part B premiums when on SSD | 6/13/2009 | LASHUNDA |
Q: Lashunda I know it says you are primarily familiar with Texas but I just have a general question. I ...
A: It probably feels as if you are not doing the right thing. However, if you have given them all the ...
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