Hi Toni:
I have Original Medicare and a Medicare Supplement Plan F. No problem in the past filing with Medicare, but beginning January 1st, my neurologist has changed how he bills Medicare. He is a small office and said that because of the amount of paperwork, he is no longer filing with Medicare.
I would have to pay up front and be reimbursed by Medicare. Can you please tell me what I need to do to submit this visit for reimbursement? Could this be the beginning of doctor problems because of Obamacare?
Thank you so much –Susan…Dallas, Texas
Hello Susan:
This year’s Medicare’s open enrollment has a completely different “environment” because many of the Medicare beneficiaries are concerned they are going to lose their doctors if they have Original Medicare with a supplement or many that are members of a Medicare Advantage plan were informed that their doctors or specialists were no longer part of that specific Medicare Advantage plan.
People really do not like change, especially when it comes to their healthcare and the doctor, who they have faith in.
In these trying economic times that we are in and with all of the changes with Medicare, as you are experiencing, 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 or any specialist charge Medicare rates or did the doctor’s office charge you their rates and want you to be reimbursed from Medicare what Medicare rate will be? That is what it sounds like to me. And who knows how long it takes for Medicare to reimburse you.
Here are a few tips that I tell my clients which can help you when having this problem:
1) Before you set the appointment ask the doctor’s office if they accept Medicare assignment and will bill Medicare directly for you. (This will be your easiest way)
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 health insurance 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 still plenty of fantastic doctors/specialist that do accept Medicare. More doctors and specialists are taking Medicare than those that don’t. Ask your primary care doctor/specialist for more than one doctor or specialist that he/she can refer for you.
Toni’s Tip on how to file a Medicare claim:
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 pages 64-65 about “What is assignment?” in the 2014 Medicare & You handbook which explains how to submit a claim if your doctor, provider or supplier doesn’t accept assignment. You can 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.
Toni King, author of the new Medicare Survival Guide®, which is a simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com. Toni is an advocate/consultant for those “Confused about Medicare” and workshops are available for churches, civic groups, senior organizations and company lunch and learn. Email questions to www.tonisays.com/ask-toni or call 832/519-TONI (8664).
