Question
I sent a more complex version of this question to John P, who declined
Am sending a more succinct version with less judgment to the question. Hopefully you can help.
Im new to Medicare due to disability . Wife is retired, both under 65. We both have GHP still in force from our employers, (they are not "Medicare Plus" plans ). Medicare A/B pays first for me but I notice less rate paid than GHP had usually paid for the same items.
GHP COB language says they will COB with all other plans for up to 100% of GHP R&C usual rates in total. However, do Medicare contracts with providers typically permit or prohibit provider from billng secondary GHP for R&C rate difference, over and above any Medicare deductibles?
Answer
Medicare will pay 80% of the allowed amount and the GHP will pay the 20%of the allowed amount that Medicare did not pay. The provider must submit the copy of the Medicare payment to the GHP. The provider is not actually billing a fee to the GHP but showing them what Medicare allowed and paid.
