Original Medicare

[Mac1958]

Interesting though, some of our clinics are begining to elimiate medicare altogether, and only accept a handful of MA PPO & HMO plans. I see this developing more as the year unfolds. BTW, I live in a major metro market, so this is not just small town clinics or stuff like that. I see a major trend begining to take hold. I wonder if it has anything to do with the recent threat by the fed's to cut medicare pyments by another 15%?

It's a real "rock & a hard place" situation. I don't expect Congress to cut Medicare payments to docs, but still many docs are leaving the system. At best, most of the rest are having to budget a portion of their practice for Medicare because payments are lower than they get elsewhere. Understandable.

This, at a time when the Baby Boomers are entering the system with so many more to come.

Who's to blame? Beats me. Don't care. But some serious changes have to be made, and soon. We could start by maximizing efficiencies and lowering the cost of care across the board...

...

 

[Todd King]

If it's true that docs are starting to leave the medicare system, then it's plan F back to the rescue!

 

[GreenSky]

If it's true that docs are starting to leave the medicare system, then it's plan F back to the rescue!

If a doc doesn't accept Medicare, how much will Plan F pay? (There is a correct answer to this). Don't everyone jump in on this, I've asked TRK3031962.

Rick

 

[Todd King]

If a doc doesn't accept Medicare, how much will Plan F pay? (There is a correct answer to this). Don't everyone jump in on this, I've asked TRK3031962.

Rick

Oh goody, a test!
If the doc doesn't accept medicare assignment then he/she is still limited to 15% over and above what medicare approves. Since plan F pays 100% of the excess charges then the client is left with 0%.

Todd

 

[GreenSky]

Oh goody, a test!
If the doc doesn't accept medicare assignment then he/she is still limited to 15% over and above what medicare approves. Since plan F pays 100% of the excess charges then the client is left with 0%.

Todd

Sorry Todd. Wrong answer!

If a doctor leaves the medicare system, then there is no supplement that will pay. Assignment is only an issue for docs that are still in the system.

Therefore, your comment "If it's true that docs are starting to leave the medicare system, then it's plan F back to the rescue!" is completely wrong.

Before you make statements like the above, you really need to learn what you are doing.

Rick

 

[Todd King]

No Rick, I'm afraid it is you who doesn't understand. Have you not heard of the Perspective Payment System? I'm not sure how things in the country of California work, but as for the states I am licensed in, this is how it works. A doctor CANNOT charge more that 15% over and above what medicare 'approves'! Whether a doctor accepts medicare assignment has nothing to do with the supplement company paying. Medicare sends the approved bill to the supplement companies, not the doctor. The supplement company then pays the doctor their 20% of the approved amount. If there are excess charges then the supp company pays them too provided the supplement the client is on has that benefit.
If it doesn't work this way, why would that benefit even be there? Think about it!!

 

[theinuranceguy]

No Rick, I'm afraid it is you who doesn't understand. Have you not heard of the Perspective Payment System? I'm not sure how things in the country of California work, but as for the states I am licensed in, this is how it works. A doctor CANNOT charge more that 15% over and above what medicare 'approves'! Whether a doctor accepts medicare assignment has nothing to do with the supplement company paying. Medicare sends the approved bill to the supplement companies, not the doctor. The supplement company then pays the doctor their 20% of the approved amount. If there are excess charges then the supp company pays them too provided the supplement the client is on has that benefit.
If it doesn't work this way, why would that benefit even be there? Think about it!!

Sorry dude your wrong. You cant make a doctor accept Medicare. Thats like a senior going into a plastic surgeons office (who may not accept any insurance) and saying you have to accept me. I have plan F.

Its just not true.

There is a difference in accepting Medicare, accepting Medicare Payment as payment in full, and billing your clients above and beyond what Medicare did not cover.

If a Dr. doesnt want to accept medicare they dont have to, which means a supp will not work.

 

[Todd King]

I never said the doctor HAD to accept medicare. I said if the doctor doesn't accept medicare he is still bound by medicare rules and regs reguarding the excess charges. If he treats someone that is on Medicare, then he has to follow those rules, period! He doesn't have to accept medicare assignment. By accepting medicare assignment he is only agreeing to accept what medicare says is the price for the particular procedure, which of course comes down to the 'amount approved'. Particular procedures are those that are listed in the DRG's.

"There is a difference in accepting Medicare, accepting Medicare Payment as payment in full, and billing your clients above and beyond what Medicare did not cover."

I am well aware there is a difference and if you go back and actually read what I wrote you can well see that I understand this.
All I was ever saying was that IF a medicare patient is seen by a doctor who WILL NOT accept medicare assignment, the doctor can still only charge UP TO 15% over what medicare would approve IF the doctor accepted medicare assignment. Plan F covers those excess charges. And yes, the plan WILL pay the doctor even though he doesn't accept medicare assignment. It's just that simple.
Todd

 

[GreenSky]

I never said the doctor HAD to accept medicare. I said if the doctor doesn't accept medicare he is still bound by medicare rules and regs reguarding the excess charges.

WRONG! If the doctor does not accept medicare, he can still treat the patient and charge whatever he wants. He is not bound medicare rules because he's not in the medicare system.

Rick

 

[The Rabbi]

Did you ever think to call Medicare at 800-Medicare. Call at 8 am EST for fastest service and get the correct answer. If a dr doesn't accept Medicare, then a senior shouldn't be seeing him unless they want to pay full price. Did everyone forget we are still a free country?