Client’s Medicare Supplement Plan Denial is Reversed, Resulting in Full Treatment Coverage

The Client

Medicare client on a Medicare Supplement policy

The Challenge

A client currently receiving on-going treatment through a major medical group was told their insurance was no longer accepted at the group’s facilities. With little flexibility to change where they receive their services, and with three claims already in process with the facility that were posted after they claimed her insurance was no longer accepted – they called their Caravus Senior Advocate for guidance.

The Solution

The Caravus Senior Market Team was already aware that many medical providers and facilities do not understand that difference between Medicare Supplement and Medicare Advantage plans, and assume if a Medicare-related plan is through a specific carrier, both plans are the same. In this case, the provider made that same assumption, and what they told the client regarding their insurance acceptance was incorrect. 

Providers must accept all Medicare Supplement plans, regardless of carrier if they accept Original Medicare. So even though this provider no longer accepted the client's carrier, the facility still needed to accept their insurance as it was a Supplement and not Advantage Plan.

Our Senior Advocacy Team called the client’s provider and after speaking with 6 different individuals, the team finally reached someone who understood the misinterpretation of the plan and confirmed the office was incorrect. They reactivated the supplement as this client’s secondary coverage and were able to add that coverage to the in-process claims that occurred during this incident.

The Outcome

The client was extremely relieved knowing their past and upcoming claims would be fully covered as they should by their supplement.