Medicare Denied? Don’t Pay Yet! How We Turned “No” into “Paid” (Plan G, Coding Fixes, 48-Hour Rule)

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Two labs on Day 1 of Medicare: one approved, one denied—and a $650–$1,000 bill showed up. Here’s why it happened and how we got it fixed.
👉 Key lesson: Medigap Plan G only pays after Medicare approves.

Most denials are billing/coding or documentation problems (e.g., orders written before Medicare start, missing medical necessity notes, wrong ICD-10, or timing rules like the 48-hour prior auth).

We had the provider recode + resubmit with proper documentation and the claim was approved; Plan G covered the 20% after the Part B deductible. 🏥📑

What you’ll learn

Routine vs diagnostic testing & medical necessity (why it matters)
Why pre-Medicare orders can cause denials
The 48-hour prior auth gotcha (real MRI example) ⏱️
Step-by-step: recode, resubmit, retro-auth, appeal
Why going to your supplement first won’t work if Medicare denies

Fix-It Steps:
Pull your MSN/EOB and call for the denial code.
Ask your doctor for an amended order + letter of medical necessity (correct ICD-10).
Have the lab/provider recode & resubmit with accurate order date/DoS and notes.
If needed, request retro-auth or file a redetermination (appeal) on time.
Document everything: names, dates, call refs, screenshots.

Chapters:
00:00 Introduction to Medicare Cases
00:15 Denied Claim Revisited
00:22 Case Details and Initial Reactions
01:58 Understanding Medicare Billing Issues
02:26 Steps to Resolve Denied Claims
05:02 Common Billing Errors and Their Impact
06:29 Conclusion and Final Advice

For any questions or inquiries regarding this video, please reach out to [email protected]
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