Medicare, Medicaid, Life and Health Insurance/Payment for surgical services


My husband has Medicare (primary) and Mayo Management Services Inc (secondary) health insurance. He had prostate surgery 11/2011. We provided the surgeon's office with both insurance cards prior to surgery and instructed them about who pays first. The insurance company billed the incorrect insurance company first. This took months to resolve. Then, they billed Medicare and it took time for Medicare to pay and provide us with an EOB. Then, they billed MMSI. MMSI denied the claim because the surgeon's office did not get preauthorization. The insurance company has a record of a person at the surgeon's office calling and the insurance company telling them the exact URL that they needed to go to to print off the preauthorization form. However, it appears that the surgeon's office never did send the preauthorization in. The surgeon's office tells me that they don't need to get a preauthorization from the secondary insurance company because Medicare is primary and if Medicare covers it, the secondary insurance company will pay it.

All of this has taken time to figure out and we are beyond the 180 day window in which I can file an appeal to the EOB. Is there anything I can do to get them to pay it?

The surgeon's office has now tried to send the preauth in, but MMSI denies it.

In the meantime, we are getting billed by the surgeon's office for the amount Medicare didn't pay. Seems they should remove that charge since they didn't get the preauthorization that would have enabled MMSI to pay it. We are also getting billed for the hospital charges that Medicare didn't pay.

Any advice you can provide is greatly appreciated. My husband is disabled; he used to work for Mayo and that's why he is covered under their Mayo LTD plan.

I Lonny
A tough one, but, has possibilities.  Carl 1-800-333-2433 and you will reach my counterparts in Minnesota.  You will reach the nearest office of the SHIP Medicare trained counselors to you.  Call them and make an appointment to  meet with them  and have them  review all the papers and help you make an possible appeals.  It appears they might be that you had received false or misleading information. They are experts and will know  of any
state laws that may apply.
Hope this helps.


Medicare, Medicaid, Life and Health Insurance

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John Pedit


Am an expert on Medicare, Medicare HMOs, and Medicare supplemental insurance. Also have extensive knowledge of Medicare especially in Mich. Have knowledge of COBRA and the Portability Act


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Council about 300 persons yearly and do many presentations on Medicare

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