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 –Stephanie…New Orleans,LA
Hello Stephanie:
Many 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 have been 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. Healthcare Reform also known as Obamacare has the public very concerned about their medical care especially when they become elderly and will need more expensive care.
Currently, I am having my own Medicare problems because my husband Jim has developed a heart condition and within the last 2 weeks has been diagnosed with throat cancer. Do not tell me that your health can change overnight! Jim was in decent health before Christmas and today is a different story!!
In these trying healthcare times, 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.
Here are a few tips that I tell my clients, which can help you when having this problem:
1) Ask the doctor’s office if they accept Medicare assignment and will bill Medicare directly for you before you set your appointment. (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 be reimbursed what Medicare pays? Doctors know they are not paid their asking rates and Medicare is not the only one who discounts 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 fantastic doctors/specialists 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 by yourself:
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 70-72 about “What is assignment and private contracts?”in the 2015 Medicare & You handbook. The handbook will explain 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.
Join Toni at Katy’s first “Confused about Medicare” workshops – Thursday April 23rd from 6:00-8:00 at the Katy Funeral Home, 23350 Kingsland Blvd, Katy, TX 77494. Workshops are at no cost. Please RSVP at 832/519-Toni (8664).
