My wife received a bill for $45 from an eye doctor for a vision test prior to cataract surgery. Medicare did not approve the charge for this service and paid nothing. Medicare did approve charges for all other services and paid the approved amounts, which the doctor accepted because he accepts Medicare Assignment.
My question is since the doctor accepts Medicare Assignment, doesn't that mean he has agreed to charge no more than the Medicare Approved Amount for a service (which in this case is $0)? If so, why did she receive this bill?
Is a doctor allowed to bill a patient for a service that Medicare doesn't pay for when he accepts Medicare Assignment?
Thanks for any information you can provide.
I didn't receive the Medicare Summary Notice yet. They come every 3 months. The doctor's bill is due this week. I do have the supplemental but that doesn't give the reason for the denial. It just shows Amount Charged $45, Medicare Approved Amount $0, Medicare Paid $0, Plan Paid $0.
My question is more general:
Is a doctor allowed to bill a patient for a service that Medicare doesn't pay for when he accepts Medicare Assignment?
I always have to pay $50 for this part of the exam. I just updated my information for my eye doctor and I signed knowing this would be a cost to me.
I always have to pay $50 for this part of the exam..."
Well that explains why Medicare didn't approve the charge! Thanks...
But my question is more general.
If Medicare doesn't pay for a service, does Medicare Assignment still apply? Your above answer sounds like it does not. I searched extensively and wasn't able to find anything about this even though I imagine it is quite a common scenario for many patients. This sounds like a doctor is allowed to charge a patient for a service if Medicare doesn't pay anything for it even though the doctor agrees to accept Medicare Assignment. Is that correct?
The receptionist at my opthamologist tells me this every time we visit the office.
This is NOT an example of "balance billing". This is a non-covered service and the patient should be informed it when checking in.
A good example is the PT my husband uses. Medicare pays for his PT sessions, but he receives and pays for other services at this center that are not covered. They are medical services, get billed to Medicare, who turn them down. We are able to deduct them if we itemize and reach the 7.5% threshold of our AGI.
What this means is a doctor cannot charge you more than Medicare feels in reasonable. Such as:
Dr charges $1000 for the service, Medicare feels $600 is reasonable and pays 80% of the $600= $480. The paper work is sent on to your supplemental who may pay the 20% Medicare does not. Which is $120. (I have a share plan with my supplimental so I always owe something)
In the case above, the difference of $400 cannot be billed to u because the doctor has excepted assignment. He excepts what Medicare feels is reasonable. Refraction is not covered by Medicare so not part of the assignment. Dr. can bill for the service.
Your supplimental is showing you that Medicare did not cover the $40. The supplimental will only pay for what Medicare authorizes so they will not cover it either. You owe the $40.
When working with Medicare and supplementals, the supplemental statement is what you go by. Thats what the doctor bills by. The balance owed on the supplemental statement.
Dr bills Medicare, Medicare pays 80% of what they consider reasonable, they then send that info to the supplemental on record. Hopefully, the supplemental pays the 20%. It all has to do with the supplemental contract. I have BS/BC. My Mom had AARP United health and we both had a share clause so always have a balance due.
I hope this helped.
https://www.medicare.gov/basics/costs/medicare-costs/provider-accept-Medicare