Hi Toni:
This July, I turned 65 and signed up for Medicare with a Medicare Supplement plan F. I went to see my family doctor and his office said that since Medicare is primary, 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?
Another question I have is what do I do if I find my doctor or specialists are not taking Medicare? I’m concerned that if I have surgery or an expensive hospital procedure that it will wipe out my retirement. What are my options?
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 family doctor 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.
- Before you set the appointment ask the doctor’s office, if they are still accepting Medicare assignment. If that office says NO, find out if that office will bill Medicare directly and accept what Medicare will pay plus the 15% Medicare Part B excess amount that Medicare will pay doctors or any Part B providers that do not accept Medicare assignment.
- If they say NO that office does not accept Medicare at all and will not file anything, then you need to decide…Do I want to pay out of pocket and get reimbursed what Medicare pays because you want to see this particular doctor or provider. Doctors know they are not paid their asking rates with Medicare. But then, 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/provider’s bills….OR…
- 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.
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 64 of the 2014 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.
Remember, Medicare is trying to help control fraud of the Medicare system and sometimes it seems a little unfair. The paperwork to document claims for all medical providers is staggering and small offices cannot absorb the costs as well as the larger providers.
Confused about Medicare and Social Security workshops –are on a vacation until after Labor Day when various Medicare/Social Security workshops will be held throughout the city. Medicare’s Open Enrollment begins Wednesday October 15th and will end on Sunday December 7th. Stay tuned for the updates on future workshops or visit www.tonisays.com for fall workshops.
Toni King, author of the new Medicare Survival Guide®, which is a simple guide explaining Medicare is on sale at www.tonisays.com. Email questions to www.tonisays.com/ask-toni or call 832/519-TONI (8664).
