Original Medicare

[GreenSky]

Andwhat do you think "leaving the system" is? It's simply NOT accepting medicare assignment! Now, after the doc has 'left the system' or doesn't 'accept medicare assignment', the doc still has a choice as to whether to treat a medicare patient or not!

Two different things.

1) Not accepting Medicare. That means the doctor can't bill Medicare so a supplement would not matter. He can then charge the patient what he wants.

2) Not accepting Medicare assignment. We are on the same page here.

Rick

 

[Todd King]

Two different things.

1) Not accepting Medicare. That means the doctor can't bill Medicare so a supplement would not matter. He can then charge the patient what he wants.

2) Not accepting Medicare assignment. We are on the same page here.

Rick

Not accepting Medicare? Does that mean he doesn't accept medicare assignment or is not accepting medicare patients? If he doesn't accept patients then of course there is no need to bill medicare.
If he does choose to accept a medicare patient, but doesn't accept assignment, then no, he cannot charge what he wants! It's limited. Like I said before, read page 35 of the Medicare and You book.

 

[Frank Stastny]

Todd,

Sorry,I'm afraid they are correct.

There is nothing that states anywhere that a doctor has to see patients who are on Medicare. I can see where the information on page 35 could be confusing, however, the information on the page assumes that the provider is "enrolled in Medicare". It makes reference to that quote in the last sentence in the first paragraph.

The operative term is "enrolled in Medicare". If a doctor is not "enrolled in Medicare" the doctor can still see patients who are on Medicare but since the doctor is not a participating provider in Medicare the doctor is not bound by Medicare rules or guidelines.

If one is on Medicare and chooses to see a doctor who has already stated that he/she does not take Medicare patients and the person wants to see the doctor anyway, the doctor can charge what ever the going rate he/she charges for non Medicare patients.

As side note, doctors typically determine the amount they charge charge their patients by taking the amount Medicare would approve and multiplying by 4. That is a pretty common way that doctors arrive at their fee schedule.

 

[Todd King]

Geez, why do people insist on putting words in my mouth. If I ever even remotely insisted that a doctor HAS to see patients who are medicare, I'm sorry. If you are reading that into what I have written here, then I'm sorry and should have worded that different.
What I HAVE said, that IF a doctor agrees to see a medicare patient, even though he has not accepted medicare assignment, AND he takes their medicare card as insurance THEN he is bound by the rules!
I've tried to make this simple but my words are obviously being misunderstood. My apologies if I have made it that way. Thought I was being pretty clear.

 

[Frank Stastny]

Geez, why do people insist on putting words in my mouth. If I ever even remotely insisted that a doctor HAS to see patients who are medicare, I'm sorry. If you are reading that into what I have written here, then I'm sorry and should have worded that different.
What I HAVE said, that IF a doctor agrees to see a medicare patient, even though he has not accepted medicare assignment, AND he takes their medicare card as insurance THEN he is bound by the rules!
I've tried to make this simple but my words are obviously being misunderstood. My apologies if I have made it that way. Thought I was being pretty clear.

This is the very reason that I prefer to talk to someone either on the phone or face to face. "E-mail" is great to get your mother "off your back" for not calling often enough but can totally suck when trying to communicate specific information.

You make reference to a doctor who "has not accepted Medicare assignment". Whether or not the doctor accepts assignment has nothing to do with agreeing to see a patient who is on Medicare.

Again, the doctor has to be "enrolled in Medicare" to accept a Medicare card from a patient. If the doctor is not "enrolled in Medicare" no doctor is going to see a Medicare patient and agree to take the patients Medicare Card.

If you are not licensed with an insurance company and write an application for a policy with that company and send the app to the home office they will not accept it nor issue the policy.

However, the insurance company may contact you and ask if you want to license with them. If you say yes, you will have to go through the process and get a writing number before the insurance company will process the application.

The same is true with Medicare. Only if the doctor enrolls in Medicare will that doctor be able to see Medicare patients and have their claims processed.

Read page 35 again and you will see that a doctor must be enrolled in Medicare to accept the patients Medicare card and file claims for that patient with Medicare.

Maybe it is me who is not being clear.

Why don't you give me a call and we can discuss it. Maybe you are right in what you are saying and maybe everyone else is also. All of us may be saying the same thing only differently.

 

[GreenSky]

Todd:

We seem to have a different definition of how and when a doctor call bill Medicare. You suggested we call either Medicare or Frank. Frank then offered to have you give him a call.

How did that call go?

Rick

 

[yeager]

Sounds like you are squabbing over words.

Doctors can choose to not take a medicare patient. If they do not take a person as a patient then obv. the patient will get no service so obv. no one will be billed. However, if they doctor sees the patient then he must bill Medicare and he then can either take the payment along with the supp payment or take the payment charge 15% more and Plan F will pick that up.

No way no how can he just see the patient and then charge whatever he wants.

 

[theinuranceguy]

Sounds like you are squabbing over words.

Doctors can choose to not take a medicare patient. If they do not take a person as a patient then obv. the patient will get no service so obv. no one will be billed. However, if they doctor sees the patient then he must bill Medicare and he then can either take the payment along with the supp payment or take the payment charge 15% more and Plan F will pick that up.

No way no how can he just see the patient and then charge whatever he wants.

What if a Medicare Beneficiarie wants to go see a plastic surgeon who accepts no kind of insurance. Does this doctor HAVE to accept medicare, or can he charge whatever he wants?

 

[yeager]

A plastic surgery, in most cases, would not be covered by Medicare. Therefore, he can charge anything he wants. But if Medicare covered this surgery, then no..he can not charge whatever he wants.

 

[Frank Stastny]

What if a Medicare Beneficiarie wants to go see a plastic surgeon who accepts no kind of insurance. Does this doctor HAVE to accept medicare, or can he charge whatever he wants?

Ramiz, the answer, as you well know, is painfully simple.

The person who is on Medicare can see any doctor who is not enrolled in Medicare if they are willing to pay the full cost of the visit or procedure.

If the doctor is not enrolled in Medicare and that person still wants to see that doctor the person who is on Medicare can do so by paying the full cost of the doctors services. There is nothing stated anywhere that says the doctor who is not enrolled in Medicare can't charge that person the full cost of the visit or procedure.

In that case it is as though the person does not have any insurance at all. Whether or not the doctor accepts assignment has nothing to do with it.

I have contacted two insurance companies and spoke to their benefits departments and they confirmed the above.

If anyone is telling their clients anything different they are misinforming their clients and could have it come back and bite them in the ass some day.