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I have been on Medicare + United Healthcare for many years with no problems whatsoever Now the Medical world has come up with whole new ways to confuse us. Well, to confuse me anyway. Example: Many doctors no longer to their own billing. "Central Business Offices" do it for them. This results in a back-and-forth "Ask them". No one has answers.
Enough of that. Just stating the reason for this question. I will soon be seeing a new doctor (I think). Finding a rather odd question on the forms they want filled out, I called the doctor's office and asked if the doctor accepts Medicare assignment. The person who answered the telephone did not understand what I meant by 'Medicare assignment'. She suggested I call their central billing office. I did. From them I came away with a "it all depends on what Medicare you have" answer. I am still not sure if this new doctor accepts Medicare assignment.
My question. Where, in this large new Medical world do patients go for straight answers and explanations? How do we keep up with what is going on so we can deal with it intelligently? Or, do they want us to know?
Well, I guess I'm not sure what you are asking either. Are you asking if they accept Medicare payments as payment in full?
Yes. "Participating" physicians accept Medicare assignments in full. Medicare pays 80% of what they approve and your supplemental plan or you yourself pay the other 20%. Doctor cannot charge you more than that.
There is another group of doctors who accept Medicare insurance but not their approved assignments. They can charge up to 15% in addition to what Medicare approved.
Then, there is a third group who do not participate in Medicare at all. They can charge you anything they want to charge.
So, if you ask if your doctor accepts "Medicare assignment", you are asking if he accepts what Medicare approves as full payment. You, I and our next-door neighbor may not have that all straight but anyone working in the doctor's office should have and should be able to answer (or ask the doctor) as to whether he/she accepts assignment. Should be able to!
Yes. "Participating" physicians accept Medicare assignments in full. Medicare pays 80% of what they approve and your supplemental plan or you yourself pay the other 20%. Doctor cannot charge you more than that.
There is another group of doctors who accept Medicare insurance but not their approved assignments. They can charge up to 15% in addition to what Medicare approved.
Then, there is a third group who do not participate in Medicare at all. They can charge you anything they want to charge.
So, if you ask if your doctor accepts "Medicare assignment", you are asking if he accepts what Medicare approves as full payment. You, I and our next-door neighbor may not have that all straight but anyone working in the doctor's office should have and should be able to answer (or ask the doctor) as to whether he/she accepts assignment. Should be able to!
There's also the Medicare Advantage Plans. Some of those are HMO's and the participants are limited to going to the doctors and other healthcare providers in their network.
I have been on Medicare + United Healthcare for many years with no problems whatsoever Now the Medical world has come up with whole new ways to confuse us. Well, to confuse me anyway. Example: Many doctors no longer to their own billing. "Central Business Offices" do it for them. This results in a back-and-forth "Ask them". No one has answers.
Enough of that. Just stating the reason for this question. I will soon be seeing a new doctor (I think). Finding a rather odd question on the forms they want filled out, I called the doctor's office and asked if the doctor accepts Medicare assignment. The person who answered the telephone did not understand what I meant by 'Medicare assignment'. She suggested I call their central billing office. I did. From them I came away with a "it all depends on what Medicare you have" answer. I am still not sure if this new doctor accepts Medicare assignment.
My question. Where, in this large new Medical world do patients go for straight answers and explanations? How do we keep up with what is going on so we can deal with it intelligently? Or, do they want us to know?
In my experience, you have to ask the question or state your situation differently. For instance,
1. I have "original" Medicare only. Do you accept that ?
2. I have Medicare plus Medigap from XYZ Insurance Co. Do you accept that ?
3. I have a Medicare Advantage plan with XYZ Insurance Co. Do you accept that ?
IOW, if you state what coverage or plan you have, the billing people seem to know how to answer.
As always, YMMV.
BTW, one question I have had for some time is, If a provider accepts any form of Medicare payment, must they accept all ?? ( with exception for out-of-network on a MA plan) ?? My first PCP under Medicare said he "only" accepted 2 specific MA plans. Not "original". Not Medigap. My new PCP said he did not think that was OK.
In my experience, you have to ask the question or state your situation differently. For instance,
1. I have "original" Medicare only. Do you accept that ?
2. I have Medicare plus Medigap from XYZ Insurance Co. Do you accept that ?
3. I have a Medicare Advantage plan with XYZ Insurance Co. Do you accept that ?
IOW, if you state what coverage or plan you have, the billing people seem to know how to answer.
As always, YMMV.
BTW, one question I have had for some time is, If a provider accepts any form of Medicare payment, must they accept all ?? ( with exception for out-of-network on a MA plan) ?? My first PCP under Medicare said he "only" accepted 2 specific MA plans. Not "original". Not Medigap. My new PCP said he did not think that was OK.
You are right about stating the plan. After trying the office, I called their billing department. I explained exactly which plan I have and what supplement I have. She agreed that my plan pays what I said it pays but she still didn't confirm that the doctor accepts assignment there.
It's most confusing. The new systems have left the right hand not knowing what the left hand is doing. So, we end up being told "I don't know; call so-and-so".
With my former doctor, I wanted to ask a question about a certain billing. The woman at his office said they don't do billing, I should call the billing office and she gave me their number. I called them. They said 'we don't do the billing; we just collect the payments and send the money to the doctor." So, there we are.
I don't know what MA plans are. Part of the newer Medicare setup? I'd think, though, that if a doctor accepts any part of Medicare, he'd have to accept all of it.
Asking a doctor if they take medicare assignment is the same thing as asking if they accept patients who are on medicare.
You may be right. I thought there is another group that do accept Medicare as an insurance but do not accept assignment. Those are the doctors who can charge up to 15% more than Medicare allows. Then, there is a third group that does not participate in Medicare at all. Not even accepting it as insurance. They can charge anything they want. All three treat Medicare patients but charge differently. And I've run into one or two who refuse to even treat Medicare patients. Don't know what their purpose is.
A friend send me an article explaining those groups. I shall see if I still have it.
Asking a doctor if they take medicare assignment is the same thing as asking if they accept patients who are on medicare.
That's not correct. I get a lot of medical care at Mayo Clinic JAX. It accepts traditional Medicare patients - but does not "take assignment" (as Hazel W would phrase it). Therefore - it is free to charge 15% more for its services (that 15% was/is covered by Medigap Plans J - now discontinued - and F - which I think is still around). Robyn
That's not correct. I get a lot of medical care at Mayo Clinic JAX. It accepts traditional Medicare patients - but does not "take assignment" (as Hazel W would phrase it). Therefore - it is free to charge 15% more for its services (that 15% was/is covered by Medigap Plans J - now discontinued - and F - which I think is still around). Robyn
And, yes, Plan F is still around. Thank goodness. I am in no mood to search for new insurance. :-) If you didn't travel overseas a lot and didn't need much medicine, Plan F was the best of the ten. I've had real peace of mind with Plan F and my supplemental to pick up the slack - slack being the other 20% plus the deductible. And, if it happened, Plan F paid that 15%. May it continue!
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