Part B Annual Deductible: Dr. Charged the Full Amount (plan, doctor, supplement)

[Inspector1489]

Perhaps there is an answer somewhere, but my search came up empty. I may contact Medicare as well unless I get an explanation here.

DW had an appointment yesterday. Total charges for the visit exceeded the 2020 Part B deductible ($198), and the office required her to pay the full amount.

We are about 18 months into retirement and the "Medicare" experience. To this point (with the exception of this provider) our Dr. visits have been handled by the office first submitting the bill to Medicare, then to our supplemental ins., then our portion - if anything is owed.
I realize this can take several months, and the Dr. would like to get what they are due up front, but what if we had another visit the same day and they wanted to charge us the deductible as well? That doesn't seem right.

My questions are:

Is our Medicare info available to the provider?

If yes, is it allowable that they can charge the entire deductible amount up front?

[Inspector1489]

Shortest thread ever?

Well...I got my answer after a chat this afternoon with Medicare. The provider can call the Medicare provider line to determine your deductible balance and request that you pay the deductible and any coinsurance at the time you receive the service.

After years of enjoying private health insurance and generally paying only the copay upon leaving the office, this was a bit confusing when my wife told me.

Oh well...now I know!

[Flamingo13]

Now "we" know to investigate things first

[old_cold]

I've seen signs up at different providers stating that deductibles and co pays must be paid but have never been required to do so. I think that is because most don't call and check...just wait for the results after submitting.

[Travelassie]

Originally Posted by old_cold

I've seen signs up at different providers stating that deductibles and co pays must be paid but have never been required to do so. I think that is because most don't call and check...just wait for the results after submitting.

Actually Medicare requires providers to collect payment of applicable copays and deductibles. They can be penalized for failure to do so. Essentially what that means, though, is that a provider cannot have a policy of just waiving the 20% copays and/ or deductibles and not requiring patients to pay them.

That doesn't mean that docs or other providers are required to collect those copays upfront before, or even after a service. It depends on the individual's insurance, and yes, the providers can and do routinely call or check online for the terms and details of coverage, copays, etc, before they even see the patient. That's why a doctor's office or other provider will ask a new patient for his/her insurance coverage, policy and contract numbers, and perhaps insurance contact information, so they can verify that coverage, see what the patient's responsibility is in terms of out of pocket expenses-before the visit, generally.

They need to make sure they have a policy in place to ensure they collect the Medicare copays/deductibles. If the patients Medicare policies include a Part B supplement that pays the annual deductible and copays, the provider will get those from the supplemental insurance and not from the patient. If there is a supplement that pays the copays but not the annual deductible, or the patient has Medicare Part B but no supplement, the provider will collect the deductible (and copays if no supplement) from the patient. In the case of Medicare Advantage plans, the copays owed by the patients for each service are written into the contract and the provider would collect these from the patients.

From what I've seen over the last maybe 15-20 years or so, there is a tendency for providers to collect copays and deductibles upfront before the service is provided. I think this is to ensure that the providers get that money, they could bill for those copays (and some do), after the fact, but the way all too many people act as though paying those bills are optional when and if they feel like it, the collection rate of upfront prior to service copays, etc. is higher than trying to get that money from mailing bills to patients. I've seen a couple of situations where a doc's office was audited by Medicare, and dinged due to what they said was failure of due diligence in collecting Medicare copays/deductibles. What actually happened was that patients were ignoring the bills for their copays and the billing department wasn't doing much to get those payments.

We don't get billed for Medicare copays and deductibles either. In our case that is because we have a secondary insurance that pays all those. Our docs, other healthcare providers routinely check our coverage, and know ahead of time that they will be paid by our insurance company.

OP, speculating here. If you/your wife happened to have Medicare coverage that included the annual deductible and 20% copays as out of pocket expenses for you, and you had not yet met the annual deductible it's possible the charges for the doctor's visit did not exceed your out of pocket expenses so they billed you for the entire amount. Assuming the doctor accepts Medicare assignment (accepts the Medicare payment plus copays, etc as payment in full ), your bill should not have exceeded the Medicare accepted amount for the service, and once you've met that deductible( $185 in 2019 and $198 in 2020), they should only bill you for copays.

[Inspector1489]

Originally Posted by Travelassie

.......

OP, speculating here. If you/your wife happened to have Medicare coverage that included the annual deductible and 20% copays as out of pocket expenses for you, and you had not yet met the annual deductible it's possible the charges for the doctor's visit did not exceed your out of pocket expenses so they billed you for the entire amount. Assuming the doctor accepts Medicare assignment (accepts the Medicare payment plus copays, etc as payment in full ), your bill should not have exceeded the Medicare accepted amount for the service, and once you've met that deductible( $185 in 2019 and $198 in 2020), they should only bill you for copays.

Thank you for the detailed and informative post.

We have an AARP UHC Plan G supplement that does not pay anything toward our deductible. In my chat with the Medicare rep yesterday, I was told that no 2020 supplemental plans paid the deductible.
I'm quite sure we were looking at a Plan F (?) before signing up in 2018, and I believe that did pay the deductible. I don't recall why we didn't select the F, perhaps cost or maybe it wasn't avaiable in our area.
Regardless - unless I'm missing something - we're responsible for the full deductible.

[organic_donna]

I went to the doctor today, and they asked that I pay $156.00 for the deductible. I told them to bill Medicare and my supplement insurance and bill me the balance. She reluctantly said she would do that, but was not pleased.