...... they are paid sums "alllowed by Medicare" Then the Medicare supplemental kicks in their 20% of just what Medicare allowed.
The amounts "allowed" by Medicare, as I understand it, can vary from region to region. Their allowable payments are based on the history of what had been charged for the same procedures and visits over a time period. (At least that's how it was when I filed claims.)
Doctors and other providers that do not "acept assignment" can charge more than what Medicare pays, but it can be no more than 15% of Medicare allowed charges. This "limiting charge" applies only to certain services, and not to supplies or items. The providers can also choose demand payment at time of service. Medicare will then send you what it paid.
My guess is that some do not accept assignment because of the payment for services Medicare allows. And perhaps because claims have to be coded properly when sent, so mistakes can be made. It might be too much of a hassle for them. My experience with Medicare claim problems have arisen from errors made by the filing office, not by Medicare.
Say, a non-Medicare, privately insured person is charged $80 for a visit. A Medicare claim would pay $50, the supplement $10, a short fall of $20.
I can see some specialists, like those who do elective cosmetic surgery, to not accept assignment (and some of those will allow for monthly payments). But, with the aging population, volume alone wouldn't be so bad.
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I'm Medicare eligible, and carry additional insurance to cover virtually any expense that might occur, including deductibles. I'm fortunate to be in relative good health, and have probably paid more in insurance premiums that I have incurred in medical expenses.
Recently a visit to the doctor to obtain a prescription renewal, nothing else, resulted in a bill from the provider for $62.00.
Upon receipt of an ''explanation of benefits'' sheet, you know, those sheets that state in bold print ''This is not a bill'', I was put to wonder as it indicated that Medicare paid $78.48, and a ''supplemental'' paid $12.40. By my math, this totalled $90.88 paid for a $62.00 bill. H'mm ?
This the opposite of what we normally hear about Medicare, and other insurances, paying less than what providers initially bill.
I took the time to call. Suffering through the myraid of the automated instructions and choices finally talked with a real person. It seems there is something out there called a ''revenue code'' that Medicare pays against, not necessarily the actual invoice. I know nothing about a ''revenue code'', and guess it wouldn't matter if I did. In any event, this was as far into confusion about the situation of the moment as I cared to endure.
So why is it that some doctors refuse to accept Medicare patients ?
I guess I'll never understand how government operates.