Don’t assume your doctor takes Medicare – ask and make sure! Otherwise you may get a surprise – a bill to pay and no reimbursement!
A Wall Street Journal article explained three options physicians have with Medicare claims.
“Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts.
The number of doctors who opted out of Medicare last year, while a small proportion of the nation’s health professionals, nearly tripled from three years earlier … Other doctors are limiting the number of Medicare patients they treat even if they don’t formally opt out of the system.
Doctors have three options for dealing with Medicare.
- Those who participate bill Medicare directly and must agree to accept its reimbursement rates for all covered services.
- So-called nonparticipating doctors still file Medicare reimbursement claims but can charge as much as 10% over Medicare’s rates for some services, and they must bill patients for the difference.
- Those who opt out can charge patients whatever they want, but they must forgo filing Medicare claims for two years, and their Medicare-eligible patients must pay out of pocket to see them.”
Click here to read the full Wall Street Journal article “More Doctors Steer Clear of Medicare” by Melinda Beck.
****
Doctor, Did You Wash Your Hands? ™ provides information to consumers on understanding, managing and navigating health care options.
Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.