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Conserving our money, keeping in mind
our health costs “over the long run” is an important issue,
which merits attention, so I would like to address the topic of Health Insurance Paperwork. First we need to discuss "Assigned Claims" and
"Unassigned Claims," which are the two possible designations
for Part B claims submitted by doctors and other providers of services
and supplies.
Doctors and
other health care providers who accept assignment must sign an
agreement to abide by the amount Medicare approves for particular
services or medical supplies. These providers are called Participating
Physicians and Suppliers. In certain situations, doctors and medical
suppliers (qualified laboratories, comprehensive outpatient
rehabilitation facilities, hospital outpatient facilities and providers
of outpatient physical and occupational therapy or speech pathology
services) are required to accept assignment.
Doctors and
other health providers who do not wish to sign participating
agreements, may charge up to 15% over Medicare's approved amount, and
these providers are non-participating. This limiting charge does not
apply to all services, supplies or equipment. A doctor or supplier may
charge more than 15% above the approved amount for durable medical
equipment (wheelchairs, walkers and oxygen), administering of vaccinations
(as of 2/1/01, assignment is mandated for the drug or biological),
prosthetics and orthotics, and surgical dressings. The key word is
"may," which gives the beneficiary the opportunity to ask the
provider to accept assignment for all bills after explaining his or her
circumstances. Non-participating providers have the right to expect
payment in full at the time of service.
You can save
money on durable medical equipment and supplies by patronizing a
Medicare participating supplier who accepts assignment. Call 1-800-MEDICARE (1-800-633-4227)
to connect you to the Durable Medical Equipment Regional Carrier
(DMERC) who can give you a list of Medicare participating suppliers.
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An item for attention that will appear early in the year
on the MSN (Medicare Summary Notice explaining action taken on the
claim) is the $135
Deductible. You could be overpaying in
the following example:
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The second doctor that you see in the year asks about your deductible
status and your answer is that you paid $135 to the prior doctor
(#1). However, doctor#2's claim was submitted first, so his MSN will
indicate a deductible of $135 or less (if charges are less than $135).
Whatever the combination of charges, you have to make certain that
you do not pay more than $135; and so you will pay #2 doctor the
deductible and receive a credit or refund from #1 doctor. I suggest
the following: (1) If your visit to #2 doctor will be soon after #1
doctor, explain the circumstance, and ask #1 doctor to file promptly.
(2) Payment to #1 doctor for deductible should not be more than the
fee; sometimes the doctor's office will automatically ask for $131.
(3) Request receipt for payment of deductible, so you can show it to
succeeding doctors.
The
important document of proof in the above is the #2 doctor MSN
indicating that application of $135 of the approved amount was made
against the deductible.
Effective October 29, 2007, all Medicare Summary Notices (MSN)
will be mailed quarterly (with some exceptions). Therefore, the $135 deductible may
appear early in the year, perhaps January or February, but you may be
scheduled to receive the MSN in April. You will have to obtain a copy from
Medicare. This aspect will be
discussed in the following segments.
Updated:
January 14, 2008
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