Should I remove Medicare from my listed hospital insurance?
May 25, 2023 9:28 AM   Subscribe

Kind of a tricky one. For my recent hospital surgery (to help remove colon cancer), my insurance, Kaiser (HMO) is the main insurance covering my stay there. However, I also have Medicare (hospital insurance, part A only) still active from the time I had SSDI temporarily about 7 years ago. Medicare is listed on the hospital insurance website. Should I remove it?

It's hard to explain, but I'll do the best I can. Back in ~2015 or so, I was on SSDI due to being jobless and having earned enough disability credits (as an under-65 year old disabled person), and as a result of getting SSDI, I was put on Medicare (part A/hospital insurance only), which I was told would be active for 9 years and then expire. I've never had a need to use Medicare, until possibly now.

I have Kaiser (HMO) through my job. I've always used their services directly at their facilities, so never had a need to use Medicare as the "backup". Recently, I was diagnosed with colon cancer, and surgery was ordered for me as an inpatient at a hospital Kaiser is "affiliated" with, with an accompanying hospital stay for observation post-surgery. My co-pay for hospital stays (which includes everything - room/board, labs/bloodwork, meds, etc) is a flat $750. I paid this $750 copay directly to the hospital upon entry.

I was told by Kaiser that they could see the 'secondary' Medicare insurance I had as well, but that Kaiser would be the primary payer for the hospital stay, and that Medicare shouldn't be involved. I want it to keep that way, because the deductible for Medicare is $1500, and don't want any complications, etc.

However, on the hospital website, I see Kaiser listed, and Medicare, with an option to remove Medicare. I see around $33k waiting to be billed/claimed (presumably through Kaiser). I don't want Kaiser to "lowball" because they know I have Medicare, and let the hospital bill Medicare as well. I don't want to pay anything above the $750 Kaiser copay I already paid or deal with Medicare, and pay their deductible/fees as well. I was told by a Kaiser rep that I should only pay $750 and that would be it.

Should it be okay/safe to just delete the Medicare coverage from the hospital website and assume Kaiser will take care of it all? I hope this question made sense. Insurance is so tricky sometimes and hard to understand!

(I added this to my recent Ask about the TV, but adding it here in case people missed it. The surgery itself went well. They found a softball-sized tumor/mass in my stomach, yikes! Said not the whole tumor itself was cancerous, some was inflammation. That would explain so many of the stomach issues I had over the last couple of years. Stayed at the hospital for 9 days. Am at home, recovering. My hospital stay itself was much longer than average, as I had some issues recovering, but no ostomy needed, thank goodness. Still waiting for the pathology results so we can determine whether or not chemo's needed.)
posted by dubious_dude to Work & Money (7 answers total)
Yes, my understanding is that you’re probably obligated to tell Kaiser that you have secondary insurance. It makes their lives more annoying and probably won’t save you money, but it could give them grounds to deny your claim if you don’t list all your existing insurance.
posted by chesty_a_arthur at 9:29 AM on May 25

Response by poster: Yes, my understanding is that you’re probably obligated to tell Kaiser that you have secondary insurance.

So sorry for the quick 'threadsit' but need to clarify — Kaiser already knows about Medicare. They already said they would be the primary payer for the hospital stay. It's the fact the hospital has my Medicare information that is making me nervous. I'm trying to find out if I can just delete that Medicare entry from the hospital website, it gives me an option to delete.
posted by dubious_dude at 9:33 AM on May 25

Sorry, I wasn’t clear — I think part of the deal is that you have to provide healthcare providers the secondary insurance as well. I’m just a person who accidentally has secondary insurance though.
posted by chesty_a_arthur at 9:45 AM on May 25 [1 favorite]

Deleting Medicare from your hospital profile doesn't make it go away. The hospital billing system probably has electronic verification to find it and pull it back into your profile. I would suggest you leave your profile as-is and let the hospital run everything through your available coverages as appropriate. I (a medical billing professional) can't imagine why having a Medicare secondary would cost you more out-of-pocket.
posted by ThePinkSuperhero at 10:38 AM on May 25 [3 favorites]

Leave it be and let the folks at the hospital billing department sort it out. There is a whole set of rules regarding who gets billed first, but that's not something you need to worry about.
posted by Alensin at 11:21 AM on May 25 [7 favorites]

Agree with above that you can't prevent the hospital from knowing you have Medicare. Also, having both Medicare and KP is a very common scenario that KP is used to. Dealing with primary and secondary billing for someone with Medicare is a fairly automatic processes for billing staff at hospitals. Basically, if KP directed you to use this other hospital, they should then only charge you as they would if you were in a KP facility. I would not worry about it.
posted by latkes at 3:57 AM on May 26

Kaiser to going to get Medicare pay for some/all of it. They will not just offload the entire claim to Medicare and tell you that Medicare will handle it.

You see a similar dynamic every time you have checked in for a KP appointment and you were asked something "Is this appointment regarding a condition as the result of an injury?" This is KP asking "Do you need to go after someone else's insurance so they can pay us??"

Basically, if KP directed you to use this other hospital, they should then only charge you as they would if you were in a KP facility. I would not worry about it.

This also applies to any hospital, assuming you are getting emergency care. I ran up a $20k ER bill after a surfing accident, and it still cost me the same $75 copay to go the nearby tier one trauma center as it would have if the ambulance had taken me to a KP facility instead.
posted by Back At It Again At Krispy Kreme at 9:07 AM on May 26 [1 favorite]

« Older Who sings "Watch Me" in the "This is Us" series...   |   How to find a job with school hours (9-3)? Newer »

You are not logged in, either login or create an account to post comments