The number one issue we see for those on the Medicare side of the BBFI Expatriate Plan are claims that are marked Pended or Closed.

If the Explanation of Benefits (EOB) or Claim Status on your MyIMG page states “Pended”, it means that IMG has received the claim, but payment cannot be made until the issue in the Reason Code Description box is resolved.

When a specific time has passed without resolution, the Pended claim is “Closed.” This does not mean IMG will not pay the claim, it means that IMG has sent three requests for the missing information with no response. When IMG receives the required information, they will reopen the claim and issue payment.

The most common reason for Pended or Closed claims is the note, “WE WILL REOPEN THE FILE UPON RECEIPT OF THE OTHER INSURANCE’S EXPLANATION OF BENEFITS.”

What does this note mean?

For those on the Medicare side of the plan, Medicare is your primary insurance. Medicare pays 80% of all claims submitted by providers.

Your provider should send the same claim to IMG since it is your supplemental or secondary insurance.

While Medicare processes claims off the original bill, IMG cannot process their part (20%) of the bill until they know what Medicare has paid on the claim.

Because Medicare will take drastic discounts off the original bill, the 20% IMG will process cannot not be determined until Medicare has paid on the claim. That information is what the Medicare Explanation of Benefits (EOB) will show IMG.

Once IMG has the Medicare EOB, they can make payment on the claim.

Many missionaries will not notice there is a problem until they receive a bill for unpaid services from a provider. The bill will show that Medicare has paid all but a small part of the original bill.

What do I do about it?

In most cases, you can take care of these claims by calling the provider and requesting two things.

1. Ask them to verify that they have your IMG information, that it is correct, and that they have submitted the claim to IMG.
2. Request that they send the Medicare EOB or Coordination of Benefits (same thing) to IMG.

Be sure to tell them that the outstanding balance will be paid 100% if they will send the Medicare EOB to IMG.

Remember, as a missionary on the Medicare side of the plan, you should not have to pay for any medical services under normal circumstances.

As always, please don’t hesitate to contact me (Mike Duff) at the office if you have further questions.