posted
I am new to this group - considered going to Dr. C in MO. I called to inquire about what, if any, Medicare covers. I was told 2 things - 1). They are not taking new Medicare patients (that is their perogative, I understand that). What I was told next stunned me.....I said - Okey.....how about if I pay out of pocket any incurred expenses and don't sign in as a Medicare patient.
I was told that BECAUSE I am a Medicare patient - I can not even have that option of paying cash.....that there Medicare has some regulation that prevents them from doing so!!!! So the long and short of it is that even if I wanted to or could walk into Dr. C's clinic - and say "forget the Medicare I will pay for this myself"....they can not do that and will not allow that.
This is the most outrageous thing I have ever heard - and had to question it. I got on the phone with Medicare - 3 different phone numbers and 3 different people later saying "they had never heard of this"....then I accidentally got a Medicare number that was "just for medical professionals"....the gal was not even going to talk to me...but I asked her to just listen to my question. She agreed to listen - she also said she had not heard of that, but would check on it....she got back to me and said that, YES - this is TRUE!!!! That the docs office would get into a heap of trouble if they allowed me to ignore Medicare altogether and pay cash!!! Unreal. And while I am venting, I find it an outrage that the gov't restricts my choices in such a manner.
So now my dilemma is this....I don't have the option of seeing Dr. C......so folks......do any of you know who in the U.S. would be next in line as a recommendation? One that takes medicare?
Posts: 45 | From mn | Registered: May 2006
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posted
i have medicare and i see an llmd who did not accept medicare for new patients when i started seeing him...so i pay cash......i have a hard time believing that this would be enforced....how could 'they' know?
Posts: 122 | From richmond, ca, usa | Registered: Feb 2004
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
I just looked into all of this for myself. There aren't very many LLMD's that take medicare because like all insurance companies, they try to dictate what is appropriate treatment and how much a doctor can charge. Medicare typically pays way below what is normally charged and the doctor must accept that amount if he wants to treat medicare patients.
My understanding is that if you are seeing a doctor that accepts medicare for any of his patients, you, as a medicare patient cannot pay cash because the doctor is obligated to bill for all medicare patients and to accept a reduced $$ amount for payment based on what medicare deems is appropriate for the geographical area.
You can pay cash if you are seeing a doctor who has opted out of medicare. They had to have signed a special agreement with medicare and opted out for all of their patients. If you are seeing such a doctor,lab tests that medicare generally pays can be covered if they still have a number with medicare even though they have opted out. If they don't have a number you cannot get any of your tests paid for by medicare.
While you could decline to mention that you are a medicare patient and pay for treatment yourself, you might consider that our LLMD's are under scrutiny and this is one area that could get them into trouble. They are treating patients in good faith, in some cases putting their career on the line so I would not want to put them in the spotlight where other areas of their practice could be scrutinized.
I've known doctor's who felt so harrassed by medicare that they simply refused to treat medicare patients any longer. If Dr. C made that decision, that would affect all of Dr. C's medicare patients so I would be inclined to NOT avoid telling the truth when asked if you are on medicare (this question is generally on the information that you fill out for the doctor's office). They ask this question because they are legally obligated to do certain things when a person is on medicare. Labs are in the same boat.
Ask his office if they will put you on a list and call you when the next opening occurs for a medicare patient.
I know it is an awful hardship. I'm taking money out of retirement to see an LLMD because I only have medicare and nothing is paid for.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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tabbytamer
Frequent Contributor (1K+ posts)
Member # 3159
posted
My first LLMD did not take any insurance. Still, Medicare covered my lab tests at IGeneX that he ordered.
Maybe it is different in Oregon?
To my knowledge, in California, it is against the law for doctors to take cash from a Medicare patient if they are a Medicare provider.
This is also true for the annual deductible. The docs office is supposed to wait until they get an explanation of benefits (EOB) from Medicare that patient has not paid their deductible for the year before the office can collect the deductible from the patient.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Hi tabbytamer,
You wrote: My first LLMD did not take any insurance. Still, Medicare covered my lab tests at IGeneX that he ordered.
Maybe it is different in Oregon?
I'm not sure why you think it might be different in Oregon. As I said in my post, if your doctor does not take medicare but still has a registered medicare number, your lab tests will be covered by medicare. This is likely what your situation was and why your office visit was not covered but your lab tests were. As far as I could tell, it is like that for all States. Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
The Medicare and healthcare and drug coverage, it's all such a huge frustration. I'm still trying to decipher what's what after over a year with Medicare as primary.
I see a doctor who does not bill any insurance at all, and she has "opted out of Medicare." In her office is a little sign asking Medicare patients to let them know in advance that they are on Medicare.
Then, at that time, they gave me a "contract" to sign, stating that I understand fully that they will not bill Medicare and that I am responsible for my bill. They require payment at time of service (good thing I still have a credit card!)
This seems to work. I don't understand why it works, because I've read somewhere that a Dr. must accept a Medicare patient, and accept a certain amount back from Medicare...not too clear on this at all. Hope I'm not adding more confusion.
Regarding the labs: Yes, the doctor does not take Medicare. However, the lab she sent me to does take Medicare. They took my Medicare card, and it was completely separate from the Dr.
Medicare has paid for ALL of my very extensive lab work. At this point the labs from this one doctor alone have come to approximately $3000.
Medicare has also covered my Igenex Lyme and co-infection testing, and these have been done twice now.
Good luck...heaven knows you need it! Best wishes, Hopeful4
Posts: 873 | From WA | Registered: Dec 2005
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posted
Terry K is correct. The doc could get in a lot of trouble. Some have opted out of the medicare system but I understand its a lengthy process.
The first doc I saw had opted out and I was able to pay cash for my visits but I had to sign a paper saying I was informed that he had opted out of medicare.
I agree that dening a citizen choice, for anything, is the worst thing a government can do.
Posts: 561 | From connecticut | Registered: May 2004
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posted
If a doctor is accepting any Medicare patients at all (even if not taking new ones), then they are not allowed to accept direct payment (cash, credit cards, anything) from any Medicare patient.
It sounds stupid (and it is), but the rationale is so that doctors are not able to pick and choose which Medicare patients they want to take.
Stop complaining; write your Congressmen. Everyone.
-------------------- Suzanne Shaps STAND UP FOR LYME Texas (www.standupforlyme.org) (Please email all correspondence related to protecting Texas LLMDs to [email protected] with copy to [email protected]) Posts: 977 | From Austin, TX, USA | Registered: May 2004
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MagicAcorn
Frequent Contributor (1K+ posts)
Member # 8786
posted
mceline,
I may have an idea that would work. How about a close relative or childhood friend, someone with a completely different name and address go with you and pay for the visit.
You pay them upfront and then they pay at the doctor's office. A gift from a family member or close friend. It is not being paid by a medicare recipient.
Maybe your state tax laws allow a medical writeoff - a little added incentive for your friend or family members assistance.
If they agree to put their name down as a responsible paying party for that visit that would be even better. But they do not have to because you are paying before you even go in to see the doctor.
It is an angle that might work and I would try it if I was in your shoes. Good luck.
-------------------- Posts: 1279 | From In hiding | Registered: Feb 2006
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posted
I didn't know a doctor could have some medicare patients and then cut off new patients. I would think he would have to say no medicare patients at all. I do not know the law, though.
Right now I am angry at Dr. C, because he charges for every little thing. My doctor called his nurse to ask a question and she had to call back and I got charged $3 for it. That's ridiculous.
Lyme patients are strapped for money as it is and I would think LLMD's would understand that. Hiker
-------------------- Hiker53
"God is light. In Him there is no darkness." 1John 1:5 Posts: 10185 | From Illinois | Registered: Aug 2004
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bettyg
Unregistered
posted
quote:Originally posted by hopeful4:
I see a doctor who does not bill any insurance at all, and she has "opted out of Medicare." In her office is a little sign asking Medicare patients to let them know in advance that they are on Medicare.
Then, at that time, they gave me a "contract" to sign, stating that I understand fully that they will not bill Medicare and that I am responsible for my bill. They require payment at time of service (good thing I still have a credit card!)
Regarding the labs: Yes, the doctor does not take Medicare. However, the lab she sent me to does take Medicare. They took my Medicare card, and it was completely separate from the Dr.
Medicare has paid for ALL of my very extensive lab work. At this point the labs from this one doctor alone have come to approximately $3000.
Medicare has also covered my Igenex Lyme and co-infection testing, and these have been done twice now. Hopeful4
Hi! There is so much I want to say about this all; hope I don't forget things.
First of all: Those REQUIRED TO SIGN PAPER stating that MD has OPTED out of medicare, get the MD's signature too. Get a copy of this to take home with you.
Then when the labs, etc. start sending you PAID RECEIPTS for charged labs/office visit, etc. MAKE COPIES OF OPTED OUT REPORT. Submit ONE copy of your/MDs signatures on opted out form.
This acts as a DENIAL FROM MEDICARE since you can NOT bill medicare directly. That's medicare told me over & over on 3 separate calls I made in 1 hr. to medicare & Iowa's BC/BS office.
BC supr. finally agree since I signed the OPTED OUT FORM, that will satisfy their need to have a mediare denial.
I've submitted around $3,000 in charged bills for my $630 office visit w/sticking me for blood, and about $2300 in lab fees.
A few labs were sent to MEDICARE. IGENEX will accept medicare!
NO ONE HAS PAID ME A CENT YET NOR REIMBURSED BY MEDICARE. I'll add more comments as I hear back from anyone.
Magic acorn, I did not like your idea of relative or friend paying. WHY NOT? My mind automatically thinks that since you will not have a check to MD provider showing YOU RECEIVED SERVICES FOR "TAX" PURPOSES!
If I pay OUT of pocket for this 1st appt, you bet I want to CLAIM $5,000 for all my bills, lodging, mileage, and cost for gas!
There may have been something else, but I've forgotten.
I agre with Suzanne; write our congressman ... get changes MADE so our LLMD's will accept medicare payments/patients!
When you send the superbill to Medicare to get the denial, does this cause any problems or repercussions for the doctor?
Then, you take the superbill, the denial, and send it to your insurance with their claim form?
Betty: If a doctor (a previous one) did not have me sign a form, can they get in trouble if I send the superbill to Medicare?
I'm not sure I understand what you're saying you attached the ``OPT OUT'' form to...are they labs? If so, are they then labs that don't accept Medicare?
Thanks.
Posts: 873 | From WA | Registered: Dec 2005
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posted
hopeful. Im not cave but I did this once with my secondary ins.
I dont know what a super bill is. Its against the law to submit a claim to medicare myself so I sent the paid bill from the doc and a copy of his "op-out of medicare" form.
It took some doing but they paid me as if they were my primary carried, which they were befor I had to go on medicare.
I changed docs after that and never did it again. Hope this helps
Posts: 561 | From connecticut | Registered: May 2004
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posted
Hi everyone - thanks for all your replies and ideas.......I'm still at a bit of a loss what to do.... Even if Dr. C (or other doc who has opted out of medicare) could allow me to "pay my own way".....when I consider the reality of it all, I don't think I could afford much more than one years worth of care - and that would be stretching the budget. We don't have secondary insurance either, so it looks like my only option is to find a llmd who takes medicare.
So......maybe I should be posting this question on the "find a doc" discussion group.....but does anyone have an idea who in the U.S. would be "runner-ups" of Dr. C, who take medicare?
Posts: 45 | From mn | Registered: May 2006
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posted
Hi everyone - thanks for all your replies and ideas.......I'm still at a bit of a loss what to do.... Even if Dr. C (or other doc who has opted out of medicare) could allow me to "pay my own way".....when I consider the reality of it all, I don't think I could afford much more than one years worth of care - and that would be stretching the budget. We don't have secondary insurance either, so it looks like my only option is to find a llmd who takes medicare.
So......maybe I should be posting this question on the "find a doc" discussion group.....but does anyone have an idea who in the U.S. would be "runner-ups" of Dr. C, who take medicare?
Posts: 45 | From mn | Registered: May 2006
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posted
While I do not know for certain, I would bet money that having someone else pay for the services does not make it any more legal. The point of this law/regulation/whatever is to keep a doctor from accepting patients based on their ability to pay. They can either take Medicare patients or not take Medicare patients. Even if you can pay yourself, if you are on Medicare, you are a Medicare patient.
This is, anyway, how I understand it as explained to me by the insurance agent who sold me my Medicare Advantage Plan from SecureHorizons Direct, and he has been in the business for a long time.
-------------------- Suzanne Shaps STAND UP FOR LYME Texas (www.standupforlyme.org) (Please email all correspondence related to protecting Texas LLMDs to [email protected] with copy to [email protected]) Posts: 977 | From Austin, TX, USA | Registered: May 2004
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posted
I believe Suzanne is correct.....a person on medicare is considered a medicare patient irregardless if they pay for services themselve.
I believe that since Medicare is a federal program - its guidelines, rules and regulations would not be different from state to state...no?
Even though I have been a medicare "patient" for many years, I have never really faced problems like this....so I really do not understand what a superbill is, what filing after a denial accomplishes - or its purpose etc....,
which still brings me to my question - who in the U.S. would be considered a runner-up to Dr. C who takes Medicare......?
Posts: 45 | From mn | Registered: May 2006
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bettyg
Unregistered
posted
I just sent you a PM with my Minn. LLMD's name, etc. ... read it carefully ok.
posted
I just sent you a PM. Cheryl
Posts: 109 | From PA | Registered: Jun 2004
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WildCondor
Unregistered
posted
They have to accept cash by law. Read the dollar bill! Legal tender for any and all transactions public and private.
To deny accepting cash is against the law, anywhere!
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MagicAcorn
Frequent Contributor (1K+ posts)
Member # 8786
posted
Betty g - The tax write off is for the person paying (not the patient on medicare). The person paying pays by check (for their records), so they they can write it off on their taxes. This is an incentative for them to help.
If you meant that you'd lose the write off for yourself, well then, yes you are right.
Acorn
-------------------- Posts: 1279 | From In hiding | Registered: Feb 2006
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The issue isn't whether or not the doctor will accept cash, but whether they can accept direct payment from the patient whether it's cash, check, credit card, or green stamps, and the law says that they can't for the reasons which I have outlined briefly above.
-------------------- Suzanne Shaps STAND UP FOR LYME Texas (www.standupforlyme.org) (Please email all correspondence related to protecting Texas LLMDs to [email protected] with copy to [email protected]) Posts: 977 | From Austin, TX, USA | Registered: May 2004
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Marnie
Frequent Contributor (5K+ posts)
Member # 773
posted
There is not ONE psychiatrist in Sarasota, Florida that takes medicare. NOT ONE. AND...none of them will accept medicare patients even IF they say they will pay out of pocket.
Too many patients have said they would pay and then don't pay.
Most "good" doctors don't take "welfare" patients. I saw this years ago when I was an OB RN(!), and it's getting worse.
I guess older people or those on disability status never need pyschotherapeutic drugs to rebalance the neurotransmitters (very tricky).
The ENTIRE health care system is so screwed up...greed plays a big part...not only most doctors, but insurance companies and pharmaceutical companies.
Everyone is out for the all-mighty buck.
Strive to be a realist when young, an idealist when older (help others to see how things SHOULD BE).
Posts: 9481 | From Sunshine State | Registered: Mar 2001
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
A doctor is not forced to accept all medicare patients just because he accepts medicare. It is perfectly legal and necessary for Doctor's to be able to limit the number of medicare patients that they accept. These articles explain the financial angle a bit. Congress - Testimonials Regarding Medicare Cuts
It is a terrible situation and will only be getting worse over the next decade. In 1994, I could not find a doctor in the town where my father lived that would take him as a new medicare patient. He was a very complicated case which would be very time consuming and difficult. Medicare was limited in what it would pay and they are much more limited now.
It is the way medicare is set up that forbids us to pay cash to a doctor who has contracted with medicare. It is not the doctor's perogative but part of the bureaucracy of medicare. As other's have said, it needs to be changed at the legislative level. Terry
[ 30. May 2006, 12:36 PM: Message edited by: TerryK ]
Posts: 6286 | From Oregon | Registered: Jan 2006
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bettyg
Unregistered
posted
quote:Originally posted by MagicAcorn: Betty g - The tax write off is for the person paying (not the patient on medicare). The person paying pays by check (for their records), so they they can write it off on their taxes. This is an incentative for them to help.
If you meant that you'd lose the write off for yourself, well then, yes you are right. Acorn
Acorn, YES, I was referring to the last stateent you wrote; the patient would not be able to have the medical write-off WHEN they repaid the money the other person wrote to the MD for. I'm glad we both clarified that. Bettyg
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