Reader Alert: 11 weeks to October 15th…Medicare’s Open Enrollment Countdown…
Hi Toni:
This week, I went to see a neurologist and his office said that since medicare is primary on my insurance, I would have to pay upfront the complete bill and be reimbursed by medicare. Can you please tell me what I need to do to submit this doctor visit and get reimbursed?
Thank you so much –Susan…Spring,TX
Hello Susan:
In these trying economic times that we are in and with all of the changes with Medicare, many doctors are not accepting Medicare and will not bill Medicare for you. They want you to submit the bill to Medicare and wait to be reimbursed. Does your neurologist charge Medicare rates or did the doctor’s office charge you their rates and want you to be reimbursed from Medicare what Medicare will pay. That is what it sounds like to me. Here are a few tips that I tell my clients that will help you.
1) Before you set the appointment ask the doctor’s office, if they are still accepting Medicare and do they bill Medicare directly.
2) If they say NO, then you need to decide…Do I want to pay out of pocket and get reimbursed what Medicare pays. Doctors know they are not paid their asking rates. Medicare is not the only one who discounts the doctor’s bills. Group and individual health insurance plans with network providers, also discounts the doctor’s bills….OR…
3) Look for a doctor or specialist that does take Medicare assignment and will bill Medicare. There are plenty doctors and healthcare professionals that still accept and bill Medicare. Even the top specialists in their field still take Medicare. Ask your primary care doctor for more than one doctor or provider that he/she can refer you to.
Here is how to file a claim if your doctor doesn’t accept Medicare assignment. You may have to pay the complete bill and submit the claim to Medicare. See page 61 of the 2013 Medicare & You handbook, which explains how to submit a claim. You need to call 1/800-MEDICARE (633-4227) and ask for Form CMS-1490S or go to www.medicare.gov/medicareonlineforms. When you have Medicare on the phone, ask them for help with filing the claim and they will be happy to assist. Good Luck, Susan
- Advice from a Loyal Houston Community Newspaper Reader :
Hi Toni:
I read your column in the local paper every week. I would like to pass some information to your readers. I had medicare part A, and coverage by my healthcare policy at work. So medicare was secondary and United Healthcare was primary. At the end of May, I retired, and signed up for medicare part B, Medigap, and part D, to be effective on June 1. However, I did not realize that I had to call medicare and inform them that I was no longer covered by United Healthcare, and medicare was now primary. As a result, medicare rejected a number of medical claims. Once I became aware of this I called medicare and got it straightened out. Let your readers know they need to notify Medicare of this change. It is not automatic.
Thank You, Steve:
That is very important information and the first I have heard Medicare inform a person about notifying “Medicare” when leaving company benefits and telling them that “Medicare” is primary and not secondary. Most of the time, when someone is retiring and leaving group benefits there is a form called “Request for Employment Information” I am not sure of the form number that you receive from Social Security and must be filled out with information about group health plan, when coverage is ending and signed from company official. I believe the form is OMB No. 0938-0787.
Toni King, Medicare advocate, consultant and author of Medicare Survival Guide and the new Confused about Medicare workshop DVD(video) available only at www.tonisays.com. Sign up for the new Medicare Survival newsletter available at www.tonisays.com. For any Medicare questions, contact Toni at www. Tonisays.com/ask-toni…
