Primary/Secondary insurance snafu

[Dragonfly64]

5. You're right - it isn't your job to oversee them,

but the doctor's office deals with a lot of patients and their insurance and you only have to handle your own. As diligent as we are, insurance coverage and benefits change constantly and most people don't know what their own plans cover. If you don't feel that the doctor's staff is going to be much help then I would call Medicare and ask them about the processing of the claim. Did they process it as secondary coverage? Even though they know that they are secondary, I have seen Medicare pay as primary even though they aren't. Did they receive the primary insurance explanation of benefits? Basically, the following:

What were the submitted charges?
What was the Medicare allowed amount?
What does Medicare show that the primary insurance paid? (Did they receive the primary insurance payment info?)
What adjustments did Medicare make, if any?
What did Medicare pay?
What, if any, is the patient responsibility?

Is it possible that the primary insurance originally paid nothing because it was out of network and THAT was the information that Medicare based it's payment on? I would definitely want to see the primary processing to see how they came up with their payment and if it was a result of a reprocessing of the original claim. It should be easy to go on the primary insurer's website and view your explanation of benefits. Then I would call Medicare with the questions above.