The bills are starting to come in

debodun

debodun

SF VIP
Location
way upstate in New York, USA
I had a Medicare wellness visit with my GP last week and already received a bill fro $170 for it from her. I have Medicare and supplemental coverage. Why am I being billed? Do I have to pay this?
 

There's not much of an answer we can give you, Deb. You need to call the doctor and ask why you are being billed. Some answers may be:

1. This is your second "wellness" visit within 12 months. Medicare only covers one.

2. The visit was incorrectly coded as something Medicare doesn't cover. Doctor's offices make mistakes on coding. Often.

3. The doctor's office is trying to "back bill" you for something, which is against Medicare rules. Let me give you an example. You have a procedure that the doctor charges $100 for. Medicare has determined that it will pay $60 for that procedure. If the doctor accepts Medicare, he MUST accept what Medicare pays for it. Medicare will then pay 80% of what they allow (the $60). Either you or your supplemental insurance will cover the other 20%. To repeat: DOCTOR'S OFFICES CANNOT "BACK BILL" YOU FOR ANY "ALLOWABLE" AMOUNT THAT MEDICARE DOESN'T PAY, UNLESS IT IS A DISALLOWED PROCEDURE/VISIT/TREATMENT, IN WHICH YOU ARE ON THE HOOK FOR IT. Always ask if the procedure is covered by Medicare. Unfortunately, doctor's offices have been known to give you the wrong answer; ultimately it is your responsibility to contact Medicare and find out if it is a covered procedure/treatment/visit. Contacting Medicare is no fun, though.

4. Are you sure your doctor accepts Medicare? There are a few who don't. Are you sure they are billing Medicare for you? Quite a few don't bill for you. You pay and then YOU have to submit the bill to your insurance or Medicare. My mother's doctor will not submit bills to Medicare. She likes him enough to put up with this. I wouldn't put up with it.

Seeing that your visit was only last week, I serious doubt they have had time to submit this to Medicare and be rejected by Medicare, so I would go with #4.

Of course, only your doctor's office can answer this. I suggest you call them ASAP and have them explain to you, in detail, WHY you are being billed for this. We can only conjecture what the problem is. Your doctor's office can TELL you what the problem is.
 

:confused:jujube mentions;

"2. The visit was incorrectly coded as something Medicare doesn't cover. Doctor's offices make mistakes on coding."

This happened to me a couple of years ago and a call to the doctor's office cleared it up. They told me to not concern myself - -they had made a coding error and they would send a corrected bill to Medicare. Might be worth checking, for a first step.:confused:
 
OR, it might not be a bill at all. Many people (I just went through this with my sister) misunderstand a statement from their health care provider of what they expect Medicare to pay and what is left over (but they will ultimately write off) as a bill. Also, Medicare sends out such a statement which confuses many people.

I would not pay the bill until I got an explanation from the provider and from Medicare and my supplement. Maybe it was miscoded, maybe the doctor's office did not send it to Medicare (if you're new to Medicare, the doc's billing office may not have realized you are now on Medicare). Or maybe the doc's office does not, as someone suggested above, directly bill medicare. Or maybe the doc's office does not bill your supplement directly.

Medical bills get tangled up all the time; all it takes is one digit to be entered wrong and everything goes pear shaped.
 
I don't think you are responsible for it... If you have traditional Medicare plus a supplement, and you have satisfied your yearly deductible if you have a plan with one.. You are DONE with out of pocket. If Medicare doesn't pay for something the Doctor eats it.. he cannot bill you. At least that is how my insurance agent explained it to me. I have Plan G supplement with a $183 yearly deductible.. and that this is the only out of pocket I will have to pay. No matter what Medicare pays or doesn't pay.
 
Butterfly said:
OR, it might not be a bill at all. Many people (I just went through this with my sister) misunderstand a statement from their health care provider of what they expect Medicare to pay and what is left over (but they will ultimately write off) as a bill. Also, Medicare sends out such a statement which confuses many people.
Click to expand...

This. Our largest local provider insists on mailing "this is not a bill" statements for everything. What a waste.
 
I've been billed before, same thing, and it was because of the doctor's coding. It took speaking with the Business Manager responsible for the billing, but it was finally straightened out.
 
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nvtribefan said:
This. Our largest local provider insists on mailing "this is not a bill" statements for everything. What a waste.
Click to expand...

Mine does it, too. I hate all that paper. I even called them and asked them to stop sending them to me, but they told me Medicare requires them to do it. They also said they can't send them electronically because Medicare requires the paper notifications. So, not only do I get the paper notification, I also get a piece of paper that says I can have an interpreter if I need one and a half a page of gobbledy-gook, but another piece of paper that tells me my Medicare rights to appeal. I wonder how much money would be saved on paper and postage if they quit doing that.
 
Well, it says it applies against your deductible. Do you have a deductible on your supplement, i.e., an amount you must pay before your supplement takes over? If the Empire Plan is your supplement, it looks like the bill was submitted to them and they paid nothing towards it.

You are going to have to call your supplemental plan and ask them what the heck is going on and why they wouldn't pay it. It looks like Medicare has paid their portion. I thought doctors who accept Medicare have to accept the Medicare payment as full payment, anyway. I don't know if Medicare has a deductible for office visits, though, as I have an Advantage plan that pays everything except the $5 I pay as a co-pay.

You probably are going to have to call Medicare, too, to find out if the doctor has a right to charge over the Medicare allowable.

I sure wouldn't pay that until I got some answers.
 
I just googled Medicare Part B deductible, and found that there IS a Medicare Part B deductible:

[h=2]"Medicare Part B deductible and coinsurance[/h] Medicare Part B requires you to pay a yearly deductible of $183 in 2017. This deductible may be applied to most Medicare-covered health-care costs that involve physician services, outpatient hospital services, certain home health services, and covered durable medical equipment."

So it looks like the question is whether your Supplement pays this deductible.
 
While you're talking to your supplemental insurance company, ask them about the Part A deductible, too. Here's what Medicare says about that:

[h=2]"Medicare Part A deductible and coinsurance[/h] Medicare Part A helps cover hospital, skilled-nursing facility, and home health-care services for each benefit period except for the deductible and coinsurance.
For 2017, the Medicare Part A deductible is $1,316 for each benefit period."
 
Debodun - Just call Empire (your insurer) Monday and ask them to explain. I can tell you, as someone who was licensed to sell Medicare supplements and Advantage plans as recently as 2015, that a lot of the information you are getting is less that accurate. So please, go to the source.
 
Butterfly said:
I just googled Medicare Part B deductible, and found that there IS a Medicare Part B deductible:

[h=2]"Medicare Part B deductible and coinsurance[/h] Medicare Part B requires you to pay a yearly deductible of $183 in 2017. This deductible may be applied to most Medicare-covered health-care costs that involve physician services, outpatient hospital services, certain home health services, and covered durable medical equipment."

So it looks like the question is whether your Supplement pays this deductible.
Click to expand...

My supplemental policy pays that $183 deductible for Medicare, but it didn't stop the orthopedist from insisting that I had to pay it last year. I just went ahead and paid it to be able to have my appointment, knowing that I could straighten it out later. I straightened it out later and the ortho refunded what I had paid since the supplement went ahead and paid them. Maybe that's what Deb's doctor's office did.
 
jujube said:
My supplemental policy pays that $183 deductible for Medicare, but it didn't stop the orthopedist from insisting that I had to pay it last year. I just went ahead and paid it to be able to have my appointment, knowing that I could straighten it out later. I straightened it out later and the ortho refunded what I had paid since the supplement went ahead and paid them. Maybe that's what Deb's doctor's office did.
Click to expand...

No it doesn't ... Your supplemental pays the $1280 co-pay for hospitalization Under Part A.. It also pays the 20% outpatient part B expenses that Medicare does not cover. You are responsible to pay your $183 Medicare part B deductible.So your doctor is absolutely correct in billing you for the deductible... after you satisfy that, you should have no more out of pocket expenses.

Both my husband and I have the Plan G supplemental and both of us must satisfy our $183 part B deductible.
 
Lolly said:
No it doesn't ... Your supplemental pays the $1280 co-pay for hospitalization Under Part A.. It also pays the 20% outpatient part B expenses that Medicare does not cover. You are responsible to pay your $183 Medicare part B deductible.So your doctor is absolutely correct in billing you for the deductible... after you satisfy that, you should have no more out of pocket expenses.

Both my husband and I have the Plan G supplemental and both of us must satisfy our $183 part B deductible.
Click to expand...

Well, unless you know what supplement jujube has, and what one debodun has, you can not know what it covers and what it doesn't cover. Some supplements cover the Part B deductible, some don't, etc. Mine does.
 
Hoot N Annie said:
Well, unless you know what supplement jujube has, and what one debodun has, you can not know what it covers and what it doesn't cover. Some supplements cover the Part B deductible, some don't, etc. Mine does.
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As far as I know Plan F is the only supplement that pays the deductible..


Who pays Medicare deductible?



Before Medicare pays anything under Part B medical insurance, you must pay a deductible amount of your covered medical bills for the year. The Part B deductible amount is currently $183 per year (in 2017).
Part B Medical Insurance: What You Pay | Nolo.com

https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

Part B deductible and coinsurance$183 per year. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.
 
So are you saying that you know that jujube and debodun have the plan G? Again, while all plan Gs are the same, not all supplements are plan G. My plan F, for example, like all plan Fs, pays the 183 deductible. There are some, such as Plan A, that do not pay $1280 or the $183. Plan K pays 50% of the $1280 but not the $183. I'm really trying to be polite, but you are misinformed and are not helping the OP.

Maybe this link will help you. Or not.

https://www.aarpmedicareplans.com/h...-guide.html&intref=AARPMedicareSupplement.com
 
Hoot N Annie said:
So are you saying that you know that jujube and debodun have the plan G? Again, while all plan Gs are the same, not all supplements are plan G. My plan F, for example, like all plan Fs, pays the 183 deductible. There are some, such as Plan A, that do not pay $1280 or the $183. Plan K pays 50% of the $1280 but not the $183. I'm really trying to be polite, but you are misinformed and are not helping the OP.

Maybe this link will help you. Or not.

https://www.aarpmedicareplans.com/h...-guide.html&intref=AARPMedicareSupplement.com
Click to expand...

Being that I worked professionally with Medicare reimbursements for nearly 15 years... I'm hardly uninformed... But.. you go ahead and take over... I'm not going to argue with you...there is no reason for you being deliberately offensive...
 
Lolly said:
No it doesn't ... Your supplemental pays the $1280 co-pay for hospitalization Under Part A.. It also pays the 20% outpatient part B expenses that Medicare does not cover. You are responsible to pay your $183 Medicare part B deductible.So your doctor is absolutely correct in billing you for the deductible... after you satisfy that, you should have no more out of pocket expenses.

Both my husband and I have the Plan G supplemental and both of us must satisfy our $183 part B deductible.
Click to expand...

Well, that would be true if I had Plan G, which I don't. Yes, it's true that Plan G does not cover the Medicare Part B deductible.

I have Plan F; it does pay the Part B deductible. You might want to look into a Plan F policy; sometimes it's not much more than a Plan G.

Oh, and I retired from a Medicare Supplement provider so I'm fairly informed about reimbursements, too.
 
Lolly said:
Being that I worked professionally with Medicare reimbursements for nearly 15 years... I'm hardly uninformed... But.. you go ahead and take over... I'm not going to argue with you...there is no reason for you being deliberately offensive...
Click to expand...

Sorry your feelings are hurt. That was not my intent. And for the record, I said "misinformed" not "uninformed". btw, Plan C also pays the Part B deductible.

And I'll leave it to the other folks on here to decide if I was "being deliberately offensive".

Hoot the Poodle
 
There are so many variations of health care plans...Medicare, Medicare Advantage, Medigap, etc.,etc., that without knowing exactly what kind of plan a person has, trying to figure out the billing in some specific instance is futile.
 
Hoot N Annie said:
Sorry your feelings are hurt. That was not my intent. And for the record, I said "misinformed" not "uninformed". btw, Plan C also pays the Part B deductible.

And I'll leave it to the other folks on here to decide if I was "being deliberately offensive".

Hoot the Poodle
Click to expand...
You were not being offensive, some folks just don't handle being wrong and corrected very well. Heck, we all have things figured out wrong... about half of what we think we know turns out to be wrong. LOL, that's why we argue/debate issues so much.
 
I received this mail on Friday afternoon after my doctor's office had closed for the weekend. I called the first thing this morning and asked why I was receiving a bill that between Medicare and my supplemental insurance, should have been paid. I also ask if it had even been submitted to my supplemental plan (which was what I had as my primary BEFORE I retired). The agent I spoke with said she had no idea what was happening, but would send it to United Healthcare. This is supposed to be the person that handles the doctors' bills and SHE HAD NO IDEA WHAT'S GOING ON???? So now the ball is in the doctor's court.
 

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