Use AB Card to See a Doc and Have No Coinsurance.

Nov 29, 2015

  1. sam816
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    sam816 Super Genius

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    I have met 3 people that are on AB card and a stand alone part D, when I told them there will be coinsurance when they use the AB card to see a doc or urgent care, their response was " I did not have to pay anything when I went to a doc."

    Did verify they are not on Medicaid, and have no employer/group coverage.

    They are seeing Vietnamese or Indian doctors.

    I checked with my upline about this and he said the docs would have to chalk it up as pro bono because Medicare will not pay the 80% until the patient pays the 20%.

    Can anyone confirm this? How would you convince these people they need to get on a MAPD or supplement?

    TIA.
     
    sam816, Nov 29, 2015
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  2. GreenSky
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    GreenSky Guru

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    Why are you trying to convince people that they should do something when they already pay zero?

    If they need to see specialists, therapy, lab, hospital they will indeed spend money. But this is what your upline should be discussing with you.

    Perhaps you need a new upline?

    Rick
     
    GreenSky, Nov 29, 2015
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  3. MBSC
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    MBSC Expert

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    I'm not aware of this. I know of two scenarios.

    1) The provider is non-participating and accepts Medicare assignment. The provider bills Medicare, receives 80%, and is writing off the remaining.

    2) The provider is non-participating and doesn't accept assignment. The provider bills Medicare at 115% balance billing, Medicare cuts a check to the patient for 80% of the 95% allowed amount, patient endorses check over to provider, and provider writes off the remaining.
     
    MBSC, Nov 29, 2015
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  4. finalexpenseguru
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    finalexpenseguru Super Genius

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    Your upline is an idiot. Medicare pays 80% of approved charges regardless of when patient pays . ever seen those EOBS from Medicare that shows they paid 80 percent and says "you may be billed" and shows the 20 percent?
     
  5. yogooglethis
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    yogooglethis Guru

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    My follow up question when someone tells me this is " do you open your mail? " many people equate not paying the balance at time of service to medicsre paying 100% however it 's not uncommon for pcp's to write off the 20% .they won't write off the upcoming 166.00 part B deductibe but it's usually a waste of time trying to motivate deadbeats to get insurance.
     
  6. sman
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    sman Guru

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    As has been stated, your upline is an idiot. How can a person know what their 20% is until Medicare processes the claim and pays their 80%?

    Time to change uplines to someone who actually knows what they are talking about.

    As for the beneficiary not paying anything, that is on the doc. If they choose not to bill the patient for the 20%, that is their prerogative. Rest assured, if these people see other docs or have most anything done on an outpatient basis, they will receive a bill. Not only for the 20%, but also for the first $166 in Part B charges for 2016.
     
    sman, Dec 1, 2015
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  7. sshafran
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    sshafran Guru

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    I don't understand why that is acceptable. Seems like it would fall under FWA. (specifically waste)

    Other areas of insurance seem to get in trouble for "kickbacks" or "waiving deductibles" like the auto-body industry or the home-repair industry.

    Not saying you're wrong, I just don't understand why it's acceptable... It raises the costs overall...
     
  8. Norwayguy
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    Norwayguy I have spent way too much time here.

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    It will always raise costs on someone as medicare pays only a percentage of what we with insurance pay. But in regards to Medicare beneficiaries medicare already sets an allowable amount so even if the doc rights off the 20% he can't charge the next grannie more.
     
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