Doctor Not Covered By Medicare

[Young at Heart]

I've been seeing the same GP doctor for over 20 years, ten of which I've been on Medicare (original Medicare). I saw the doctor in August. The claim was rejected with the message "Doctor Not Covered By Medicare". The doctor hasn't billed me. Anyone else ever received a denial for this reason? What exactly does "Doctor Not Covered By Medicare" mean?

 

[C50]

I've been seeing the same GP doctor for over 20 years, ten of which I've been on Medicare (original Medicare). I saw the doctor in August. The claim was rejected with the message "Doctor Not Covered By Medicare". The doctor hasn't billed me. Anyone else ever received a denial for this reason? What exactly does "Doctor Not Covered By Medicare" mean?

Sounds like the doctor has decided not to accept Medicare insurance any longer. Best to call the doctors office and find out.

 

[Young at Heart]

Doctor is part of an Accountable Care Organization (ACO).

 

[elderkaren]

This could happen if the doctor opted out of the Medicare program or if they never enrolled in the first place. As a Medicare beneficiary, you're generally only covered to see doctors who are part of the Medicare network.

 

[That Lady in PA]

I've been seeing the same GP doctor for over 20 years, ten of which I've been on Medicare (original Medicare). I saw the doctor in August. The claim was rejected with the message "Doctor Not Covered By Medicare". The doctor hasn't billed me. Anyone else ever received a denial for this reason? What exactly does "Doctor Not Covered By Medicare" mean?

Call your doctor's office and ask.

 

[AnneTeak]

Time to find another doctor. It will cost you too much to continue seeing him.

 

[CooCooforCoCoPuffs]

If a doctor or medical facility opts out of Medicare participation it is because they do not want to follow duty of care guidelines and or take Medicare pay boundaries/rules. OR they cannot get INTO taking Medicare because of some violation of the duty of care or pay guidelines: perhaps due to fraud in payments OR malpractice that will cause or caused a Medicare patient (or several patients) medical/physical harm.

Docs and hospitals are not required to TELL anyone they don't qualify to be in the Medicare system.
Some docs and hospitals only provide "exclusive" or "executive" services which is essentially paid by very well off patients and clients, or insurance programs that cost A LOT more than average Americans can afford.

 

[Michael Z]

I would think the notice is meaning “Doctor no longer accepting Medicare for payment”. There could be a variety of reasons for this.

Are you on an Advantage plan? If not, you should be able to easily find another doctor as most accept basic Medicare.