rubindj

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 [url]www.medicare.gov[/url]