Insurance Agent Forum

[MedSuppPro]

If doctors don't accept assignment, then isn't it better to have a MedSupp with excess charges covered?

Fewer Primary Care Physicians Take Medicare Patients -- Medical Services, Hartford Hospital, American Medical Association -- Courant.com

[policy doctor]

Welll yes,,,plan F or G would pick up excess, just remember excess has a cap of 115% of medicare allowable.

But this article is talking about drs. limiting the number of new patients either on Medicare or not. The medicare patients don't get enough reimbursement from Medicare....what I don't get is why the doctor doesn't refuse assignment and ask for full price. then the client would pay the difference between dr's bill and Medicare 80% payment, and get reimbursed partly or wholly from ins co.

Some doctors want the whole bill paid up front, and just assist patient in filing claims.

This nag has been beat to death in some old posts so you may want to scroll. The search tab doesn't always find stuff so scrolling seems to work.

[GreenSky]

You've really asked 2 questions:

1) Is it better to cover the excess charges?

Generally it is a waste of money. The extra 15% for an occasional office visit may not justify the additional expense. But if the math works, then yes.

2) If docs don't take Medicare, what should the patient do?

If they don't accept Medicare then it doesn't matter if they have a supplement or not. And a doctor can't take a Medicare patient, charge them up front, and then help them file a claim. Only a provider can file a claim and they are still subject to Medicare's limiting charges. Some doctors cheat the patient by doing just that, but it's illegal.

Rick

[policy doctor]

Whoa Rick you saying just any doctor cannot take a medicare patient unless he(dr) is in the Medicare system, even if the doc doesn't take assignment? Am reading pg 16 in 2007 Choosing a medigap policy.

Cripe...and why is it illegal for them to help patient file claim? Some patients can't fill out forms.

[GreenSky]

Originally Posted by policy doctor

Whoa Rick you saying just any doctor cannot take a medicare patient unless he(dr) is in the Medicare system, even if the doc doesn't take assignment? Am reading pg 16 in 2007 Choosing a medigap policy.

Cripe...and why is it illegal for them to help patient file claim? Some patients can't fill out forms.

Unless the doctor is in the Medicare system, he can't bill Medicare.

According to CMS, only a doctor can file a claim with MEDICARE. (Maybe I would have a different answer if I asked a different CMS employee).

Rick

[policy doctor]

Talking to myself here. Yes, of course, the doctor would need an id number from Medicare so they could track their reimbursement to him for that claim(s).
Overview

I'll research that illegal part.

[MedSuppPro]

OK, so doctors not accepting Medi patients or accepting assignment is a non subject for you. It’s a broken record. Yet the record plays on…

“A 10.6 percent Medicare reimbursement reduction in July and an additional 5 percent cut in 2009… “ -- AMA

The article also points out a few disturbing trends. It states that some doctors had accepted assignment and are no longer doing so. It also goes on to state that some doctors are dropping out of some of the MA plans.

Isn’t that why we call this a forum and not google?

[midwestbroker]

I only knew of one Dr in the KC metro that did not accept Medicare assignment. I am sure there are more, but they are few and far between.

If you do run into the situation, then I would advise that you call the Dr's office while at the appointment to see how they would handle billing.

[policy doctor]

If doctors continue to limit the number of Medicare patients, or just refuse them entirely, it will be a MAJOR concern to all of us insurance people. And i have read the same articles since last fall when they started talking about this.

Plus, I am tryng to find a Medicare doctor for my mother. Surprise...not that easy. So here we have an aging population with a shrinking doctor base. And this has happened to my MA(pffs) clients also....where their provider abruptly quit taking MA plans. What part did Medicare play in that decision, I don't know. Other agents posted the same experience this past fall/winter. I remember seeing your posts so I'm sure you read some of that too.

This could be a dilemma....what we thought was guaranteed may not be....kinda like the almighty dollar is not so mighty anymore.

[GreenSky]

If this is a dilemma, wait until we get Obama or Clinton care.

Rick

[MedSuppPro]

The current Medicare physician payment system places seniors' access to care at risk year after year by tying payments to the gross domestic product. It is keeping payment rates about the same as they were in 2001. The 2007 Medicare Trustees report predicts total cuts of about 40 percent by 2016.

It ultimately effects access to care for military families, as payment rates in the TRICARE program are tied to Medicare rates. This issue has implications for MA plans.

The Medicare physician payment formula varies by location. Some of us older agents can recall when excess charges where very common. Most of us know that history repeats itself. Another way to look at it is cost shifting.

Maybe we should bring back the United American MMX+ plan!

[Frank Stastny]

Originally Posted by policy doctor

Welll yes,,,plan F or G would pick up excess, just remember excess has a cap of 115% of medicare allowable.

....what I don't get is why the doctor doesn't refuse assignment and ask for full price. then the client would pay the difference between dr's bill and Medicare 80% payment, and get reimbursed partly or wholly from ins co.

Some doctors want the whole bill paid up front, and just assist patient in filing claims.

I'm not sure I understand the above statement. If a doctor refuses to accept assignment then the doctor is entitled to charge 15% more than Medicare approved. That part I know. However, the doctor cannot refuse to accept assignment and then charge the patient the full cost the doctor would expect to receive from a non-Medicare patient. That is what doctors were allowed to do before the changes in Medicare that took place around 1994.

Accepting assignment simply means the doctor agrees to accept the amount Medicare approves as full payment. Not accepting assignment means the doctor can charge 15% more.

Doctors who want the whole bill paid up front from a patient on Medicare must file the claim with Medicare, not assist the patient in filing the claim. I don't believe that a patient can file a claim with Medicare. When the doctor receives payment from Medicare then the doctor is legally obligated to reimburse the patient for the money they paid.

Before automatic claims filing, early 90's, patients had to file their claims with the insurance company but the doctor has always had to file the claim with Medicare.

I do not believe it is legal for a doctor to see a Medicare patient and then not file the claim with Medicare.

[Frank Stastny]

Originally Posted by policy doctor

Plus, I am tryng to find a Medicare doctor for my mother. Surprise...not that easy. So here we have an aging population with a shrinking doctor base. And this has happened to my MA(pffs) clients also....where their provider abruptly quit taking MA plans. What part did Medicare play in that decision, I don't know. Other agents posted the same experience this past fall/winter. I remember seeing your posts so I'm sure you read some of that too.

Does your mother have a Supplement or a PFFS plan? I would hope you put her with a Supplement.

Medicare doesn't play any role in the decision for a doctor to opt out of a PFFS plan or any MA plan other than having developed a crappy plan. That is entirely the doctors choice. The government still hasn't taken that decision away from the doctors, at least not yet.

I believe that we are going to see more and more doctors opting out of the PFFS plans, especially if that doctors practice is not in a large metro area. PFFS plans suck in rural America.

[Frank Stastny]

Originally Posted by midwestbroker

I only knew of one Dr in the KC metro that did not accept Medicare assignment. I am sure there are more, but they are few and far between.

If you do run into the situation, then I would advise that you call the Dr's office while at the appointment to see how they would handle billing.

The doctor accepting assignment or not accepting assignment has nothing to do with billing. From the patients perspective the billing is handled by the doctors office regardless. The patient never enters into the equation.

[Frank Stastny]

If doctors do not accept assignment they are not making an additional 15% more.

If they do not accept assignment Medicare reduces the amount they would usually approve by 5%. The doctor can then add 15% to the reduced amount. So, the doctor is really getting around 9.25% more instead of 15%.

Also, both the insurance company and Medicare send the checks to the doctor's patient. Now the doctor has to spend additional money sending out statements or in some cases, not getting paid at all.

If they do accept assignment they get their checks directly from Medicare and the Supplement company. No billing necessary. That is the main reason that there was such a large percentage of doctors who began accepting assignment when that change in the law took place.

I doubt that we are going to see huge numbers of doctors who now accept assignment begin not accepting assignment.

[GreenSky]

Originally Posted by Frank Stastny