Really dumb Medicare question, LOL

[jzeig104]

Originally Posted by Ariadne22

AG in MN filed a complaint w/Medicare against Humana Medicare Advantage:

Minnesota attorney general asks U.S. to investigate Humana | Star Tribune

Behavior cited in story is typical of what I experienced the couple of times I had to deal w/UHC. Denials, endless loop w/CS w/no resolution. The bigger they are, they worse they get. It's all about their bottom line. They hope you and/or your doctor will give up. Darn shame the docs have to fight w/insurance companies for authorizations of medically necessary protocols - and payment. Stress on patients is just plain immoral.

Yes, everyone I talked to, including doctors offices, said to avoid Humana like the plague. They even had this reputation when I was consulting for insurance.

[BuffaloTransplant]

Originally Posted by StressedOutNYer

Okay, so I'm busily researching all facets of Medicare prior to signing up in a few months, and I have a REALLY silly question, lol

I understand that when I go to a doctor, for example, that Medicare pays 80% of the "approved amount" and I pay 20% of that amount. (assuming it's a doctor who accepts assignment for the purposes of this example, and that I do not have a Medigap policy). So let's say the approved amount is $200 for ease in computing; Medicare pays $160 and I am responsible for $40. But when and how do I pay that amount? Does Medicare send me a bill for $40 once the paperwork for the visit goes through the system, or does the doctor's office send me the bill for $40 after they get paid from Medicare? Or would I have to pay the $40 up front at the time of service?

Would you believe that NOWHERE in any of the online or print resources, including the Medicare and You publication, does it say when that "20% of" amount comes due, or who asks for it? LOL

ASK AT THE MD'S OFFICE!

Our MDs bill Medicare. Medicare pays them ( or puts it toward the deductible) - Medicare pays the MD and then the bill gets sent on to our secondary insurance. The secondary insurance pays and then we get the final bill.
I imagine if you have an MD accepting Medicare (and it is traditional A&B Medicare (nothing additional)) where you pay the 20% of Part B, they will simply take your card, copy it and send the bill to Medicare. If you have otherwise? Who knows?

[Never2L8]

Actually, I don't think any of my current MDs do their own billing anymore (meaning that it's handled right at the office where the care is given). Usually the patient's visit paperwork/info is sent to either a billing service or to the billing dept of the "network/group" to which that doctor's office belongs.

None of my doctors could even tell me what the Medicare Approved Amount is for a particular visit. What the billing depts do is to submit the same fee amount (say, $350) for that procedure code, regardless of whether the bill is going to be paid by the patient (self pay/no insurance), a standard insurance company, or Medicare policies. Then the amount is adjusted at the receivers end (whoever that may be).

My oncologist's office told me that they used to have separate fee schedules for Medicaid, Medicare, standard insurance, and self pay. That was back when they used to do their own billing. But nowadays they send the same fee bill (for that procedure code) regardless of who's going to end up paying it, and let the respective billing personnel figure out what the final amount "should" be.

Marcus Welby's long gone, LOL