Just a reminder to Medicare enrollees w/out secondary coverage - Request "assignment"

[pinto]

A simple question prior to medical care may save you some money. Ask the providers if they will accept assignment. That means that they will accept Medicare reimbursement as payment in full. Not all do, but it's a question too few patients pose prior to receiving care.

Even in an ER setting, a designated representative can make the request during the admitting process.

[bemildred]

1. Yes, always ask what it costs and who pays, and then think about it. nt

[pinto]

2. Yeah. I'd question thinking about it in an ER setting though. Care then is usually paramount.

[bemildred]

3. It can be tough, and if you have no money, possibly irrelevant anyway.

But even then, you don't have to freak out as much when the bill comes.

[postulater]

4. That may be true if the doctor is a 'participating' doctor

but if the doctor is a 'non-participating' doctor then while there is a lower fee, the patient still pays 20%, even if the doctor accepts assignment.

Assignment just means Medicare pays the doctor directly. Non-assignment means Medicare pays the patient.

[SheilaT]

5. I was under the impression that if a doctor

or hospital accepts Medicare, then whatever the Medicare reimbursement is, that's all they can charge.

If Medicare does not cover your particular procedure or whatever, then you'll have to pay.

[Sgent]

6. Ok.. some clarification

There are 3 types of providers as far as Medicare is concerned:

1) Participating -- they must file your claims and accept Medicare's fee schedule as payment in full. You will still owe your cost sharing amount (20% for doctors, per day for hospitals), but it will be based on the Medicare fee schedule.

2) Non-Participating -- They will usually file your claims -- but not always and will not accept the Medicare rate as payment in full. However, this is a small group since by law they must accept Medicare + 5% as payment in full. Medicare will pay you based on 95% of Medicare's pay schedule (so for a doctor it would be 95% of fee schedule x 80% = check to you. You will pay doctor 105% max of Medicare fee schedule.)

3) Private non-contracting -- they have nothing to do with Medicare, and Medicare reimburses nothing for their services. You must sign paperwork agreeing this prior to being seen.

A given doctor must choose the same category for all portions of their practice (they cannot be #1 at a hospital and #3 in their private practice). Most providers do not do #2 because you cannot collect that much more, and collection issues are much more difficult.

I've never seen a hospital be anything other than either #1 or #2. Usually I only see #3 in the case of plastic surgeons, dermatologists, etc.