> Basic Hospital Basic-hospital plans cover only in-hospital (inpatient) care, not other services. This benefit also may be limited to an approved or network facility. Hospitalization in a different facility may qualify for less coverage or none at all.
> Exclusive Provider Organization (EPO) EPOs allow subscribers to visit any physician within the contracted network without prior approval or referrals. Services received outside the network may not be covered.
> Preferred Provider Organization (PPO) PPOs are comparable to indemnity plans, although they require subscribers to choose their health-care providers and health-care facilities from a preferred-provider list. Because the preferred providers have agreed to the plan's requirements, including discounted fees, subscribers have a financial incentive to stay within the network.
When you have a Medigap policy, the insurance company must pay your doctor or provider directly when:
Your doctor or provider has signed an agreement with Medicare to accept assignment of all Medicare claims for all their Medicare patients, and
You tell your doctor's office to put on the Medicare claim form that you want Medigap insurance benefits paid to the doctor or supplier. Your doctor should put your Medigap policy number and the company name on the Medicare claim form. You will need to sign the claim form or have your doctor keep your signature on record. Make sure this information is correct.
When these conditions are met, the Medicare carrier will process the claim and send it to the Medigap insurance company. A Medicare carrier is a private company that has a contract with Medicare to pay Part B bills. The carrier will send you a Medicare Summary Notice. Your Medigap insurance company will pay your doctor or provider directly and then send you a notice. If you don't get this notice, you may ask your Medigap insurance company for it.
In most cases, Medicare claims are sent directly to the insurance company, even if the doctor doesn't accept assignment on all claims.
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Did You Know?
Payments you receive from qualified long-term care insurance contracts will generally be excluded from income
As reimbursement of medical expenses received for personal injury or sickness under an accident and health insurance contract. Also, certain payments received under a life insurance contract on the life of a terminally or chronically ill individual (accelerated death benefits) can be excluded from income. Refer to Publication 17, Your Federal Income Tax, Chapter 13, Other Income.
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Vermont and nationwide:
Mar 02, 2007 - Group Insurance Coverage Most Americans get health insurance through their jobs or are covered because a family member has insurance at work. This Read more >
Mar 02, 2007 - The Medigap Insurance Company When you have a Medigap policy, the insurance company must pay your doctor or provider directly when:
Mar 02, 2007 - More Americans Struggle With Health Care Costs TUESDAY, Dec. 12/2006 (HealthDay) More Americans are forced to spend more of their family income on health care, and more Read more >
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general information related to insurance issues commonly encountered.
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