I am a little lost on what medicare pays for i have been going to the doctor like crazy the last few months because i never feel good.

But i am a bit confused the doc says the type of medicare i have pays for everything yet when i was at another doctor <my first doctor> he kept billing me 60 dollars each visit. And since my first doctor was not helping me find out what was wrong with me i found a new doctor. But this doctor says that my old doctor was not suppose to take 60 bucks from me each time.

Right now i am getting to lumps removed and even then he says i still pay nothing.... someone help me i don't understand medicare


on my medicare card it says i have Hospital (part a) and medical (part b)


Also i get ss fot having cerabal paulsy <spelled wrong i think>

I am a little lost on what medicare pays for i have been going to the doctor like crazy the last few months because i never feel good.

But i am a bit confused the doc says the type of medicare i have pays for everything yet when i was at another doctor <my first doctor> he kept billing me 60 dollars each visit. And since my first doctor was not helping me find out what was wrong with me i found a new doctor. But this doctor says that my old doctor was not suppose to take 60 bucks from me each time.

Right now i am getting to lumps removed and even then he says i still pay nothing.... someone help me i don't understand medicare


on my medicare card it says i have Hospital (part a) and medical (part b)


Also i get ss fot having cerabal paulsy <spelled wrong i think>
I hope you were not paying the $60 for each visit. That doctor had no right to charge you.What kind of doctor was this?Was it a specialist or regular MD? Do you have a secondary insurance to cover your deductibles and copays?

I hope you were not paying the $60 for each visit. That doctor had no right to charge you.What kind of doctor was this?Was it a specialist or regular MD? Do you have a secondary insurance to cover your deductibles and copays?


I was paying 60 bucks each time and he was my family doctor. The only type of health insur. i have is medicare

Ok, for outpatient treatment, here is the breakdown for someone with medicare alone, and who visits a participating physician:

1) $100 deductible per year
2) 20% copay of any office visit, procedure, or injection. Lab's have no co-pay. The 20% is of the Medicare approved amount (also called allowable).
3) Dr. Bills and recieves the other 80% from Medicare.

In the case of a non-participating physician, the following happens:
1) Dr. makes you pay up front
2) Dr. cannot charge more than 104.5% of the Medicare allowable. For instance, if the Dr. usually charges $100 for a service, but Medicare only allows $50, then he cannot charge you more than $52.25
3) Dr. submits claim to Medicare
4) Medicare cuts you a check for 80% of the amount you paid, after you meet the $100 deductible.

Most all doctors fit into one of the above categories; however, this is a third called opted-out physician.
1) You sign statement, acknoledging that this physician is opted out of Medicare, and you agree to be responsible for the entire bill.
2) Financial arrangements are between you and the doctor -- Medicare plays no part.
3) No visit to such a physician may be billed to Medicare at all.

To check on the status of a particular physician, go to www.medicare.gov

ok, THIS IS HOW MEDICARE WORKS

There are three classifications of Dr's in Medicare

1. Participating- these Dr's bill Medicare directly. Medicare determines the fee for the service depending on what procedure code the dr uses. Medicare then pays the Dr. 80% of their aproved fee. The Dr. is required to collect the 20% copay, and any part of the yearly $100.00 deductible.

2. Non Participating- these Dr's get payment from the patient, and then the patient sends the bill to Medicare to get reimbursed 80% of the allowed fee. These Dr's still cannot charge more than the Medicare aproved fee for the service.

3. Private Arrangements- There are some Dr's that do not deal with Medicare at all. They Opt out of the Medicare program and can charge anything they want. I do not believe patients will be reimbursed at all from medicare. I'm not sure about that one.


Either way if you do not have a secondary insurance, your other dr should not be taking the Medicare payment as payment in full. If he does not collect the copay or deductible then he is breaking the law and there are quite severe penalties for this.

Let me know what happens

Quote:
2. Non Participating- these Dr's get payment from the patient, and then the patient sends the bill to Medicare to get reimbursed 80% of the allowed fee. These Dr's still cannot charge more than the Medicare aproved fee for the service.


Just to clarify, even a non-participating physician must send in a claim for services rendered, but the payment will go to the patient. The Dr. may charge no more than 110% of the non-participating allowable, which is 95% of the participating allowable. In english, this means the Dr. may charge 4.5% more than a participating Dr.

The above is for Medicare patients only, non-medicare and private have different rules.

rubindj