# The bills are starting to come in



## debodun

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?


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## Trade

debodun said:


> 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?



The way I understand it you are supposed to get one wellness check up for free. Medicare should pay for it. 

https://www.medicareinteractive.org...reventive-care-services/annual-wellness-visit


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## jujube

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.


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## DaveA

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.


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## Butterfly

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.


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## Lolly

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.


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## nvtribefan

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.



This.  Our largest local provider insists on mailing "this is not a bill" statements for everything.  What a waste.


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## Katybug

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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## Butterfly

nvtribefan said:


> This.  Our largest local provider insists on mailing "this is not a bill" statements for everything.  What a waste.



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.


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## debodun

Here's the gist of the bill, with personal info cut out. Does this clarify anything?


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## Butterfly

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.


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## Butterfly

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.


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## Butterfly

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."


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## Buckeye

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.


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## jujube

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.



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.


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## Lolly

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.



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.


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## Buckeye

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.



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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## Lolly

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.




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.


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## Buckeye

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


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## Lolly

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



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...


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## jujube

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.



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.


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## Buckeye

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...



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


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## Don M.

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.


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## dpwspringer

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


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.


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## debodun

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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## Butterfly

I think the doctors' offices' personnel get pretty overwhelmed trying to keep up with the zillions of different plans and what they do or do not cover, so I wouldn't blame her. From the dates on the bill, it looks like maybe they sent it to Empire first, and they didn't pay because Medicare hadn't paid anything yet.  Who knows, but it's only a glitch and will get straightened out one way or another.  This is why we all need to pay attention when we get those bills.


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## Sunny

Medicare is my primary, BC/BS is my secondary. Between them, they have nearly everything covered. Often, I get a statement from Medicare saying I owe (x amount) to the doctor, above and beyond what they are paying. This is before BC/BS has a chance to kick in. I always just ignore it. I don't really owe it.

Sounds like you are also in that in-between period. Just wait; don't pay anything!


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## Lolly

Sunny said:


> Medicare is my primary, BC/BS is my secondary. Between them, they have nearly everything covered. Often, I get a statement from Medicare saying I owe (x amount) to the doctor, above and beyond what they are paying. This is before BC/BS has a chance to kick in. I always just ignore it. I don't really owe it.
> 
> Sounds like you are also in that in-between period. Just wait; don't pay anything!



Best Medicare advise I have gotten...  DON'T PAY ANYTHING until Medicare weighs in and you get a bill that correlates to what Medicare and your Supplement agree you owe.


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## debodun

I will likely have to pay SOMETHING, my issue is with the doctor's office and why they didn't send the balance to my supplemental carrier.


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## AZ Jim

Lolly said:


> 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.


I have Mutual of Omaha and it does pay deductible.


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## CeeCee

I pay $125 for my Medicare Part B and nothing for my supplemental which so far has been excellent.  I may get it for free because I'm on widows benefits only.

I pay nothing at my drs office for a visit.  My X-ray and MRI cost me $5 and my prescriptions are usually $5.  So far I haven't had to pay for anything Ive had done.

I have a mammogram scheduled for Nov 8 and that will cost me $5 also.  

I always make sure I ask what something is going to cost me out of pocket BEFORE I have it done.

Obviously I can't do that in an emergency situation but so far so good.

only negative to my supplemental is that I have to have things done in Fresno and I live alone so my daughter will have to drive 3 hrs to stay a day with me when needed.  She's very busy so that won't always be easy.


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## Lolly

AZ Jim said:


> I have Mutual of Omaha and it does pay deductible.



It does if you selected Plan F..   I have plan G and it does not pay the deductible but the difference in my premiums between Plan G and Plan F makes me better off paying the deductible than paying the higher Plan F premium.  I actually save money.


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## GreenSky

You don't have a supplement.  You have a Medicare Advantage HMO.

Rick


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## GreenSky

Plan G in most areas is a great value.  My clients almost never choose Plan F when we go over how much you must pay an insurance company to have you avoid the $183 Part B deductible.

I also use Plan N much of the time.  Since excess charges are only an issue about 4% of the time, the differential between G and N can be $40-50 a month in exchange for paying up to but never more than $20 for an office visit.

Rick


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## Lolly

GreenSky said:


> You don't have a supplement.  You have a Medicare Advantage HMO.
> 
> Rick



I think that's where people who have the Medicare Advantage plan HMO's get confused..  They signed away their Medicare and have opted for a plan administered by a private insurance company.  They do not have Medicare....  There part B premium is sent directly to the HMO provider...


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## GreenSky

Lolly said:


> I think that's where people who have the Medicare Advantage plan HMO's get confused..  They signed away their Medicare and have opted for a plan administered by a private insurance company.  They do not have Medicare....  There part B premium is sent directly to the HMO provider...



Actually, the entire average cost for someone on Medicare in their area is sent to the insurance company.  It's more like $1,000 per month.

I help people with Medicare Advantage (HMO and PPO) if that's what they want.  For me, I'll go with Medicare and a high deductible Plan F in a year.

Rick


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## Lolly

GreenSky said:


> Actually, the entire average cost for someone on Medicare in their area is sent to the insurance company.  It's more like $1,000 per month.
> 
> I help people with Medicare Advantage (HMO and PPO) if that's what they want.  For me, I'll go with Medicare and a high deductible Plan F in a year.
> 
> Rick



I figured that more was sent to the Insurance company... like the money to cover  Part A.. hospitalization, but I didn't know the dollar amount.   I completely agree with you.. I will stick with traditional Medicare.. I think that in the long run and particularly if a person is stricken with a major illness like Cancer... Traditional Medicare is better coverage.


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## Butterfly

debodun said:


> I will likely have to pay SOMETHING, my issue is with the doctor's office and why they didn't send the balance to my supplemental carrier.



Because they made a mistake.  It happens all the time when you are dealing with human beings.  It will get straightened out one way or another.


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## GreenSky

MelissaKay said:


> I don't know if that's true regarding "the doctor eats it." If Medicare doesn't pay the doctor is allowed to charge up to a certain percent of the total charges, this is called Part B excess charges. Your Plan G does cover these extra charges, I believe Plan F does as well.



That's not what excess charges mean at all.  Excess charges only come in to play with about 4% of doctors when they don't accept assignment of the claim.  So neither Medicare nor any supplement will pay the doctor directly but will pay the patient only.  If Medicare doesn't allow a procedure nothing will pay on behalf of the patient.

Plan F & G do pay excess charges.  I have hundreds of clients with Plan N (which does not pay excess charges) and not one of my clients has ever had a provider legitimately charge them.

Medicare really isn't rocket surgery but I find in general that when people do their own research and/or just call a few insurance companies they wind up paying more than necessary.  It may not be easy to find an independent agent that really specializes in Medicare but that's really the best way to do things.  There is no cost to use a professional.

Rick


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## Lolly

GreenSky said:


> That's not what excess charges mean at all.  Excess charges only come in to play with about 4% of doctors when they don't accept assignment of the claim.  So neither Medicare nor any supplement will pay the doctor directly but will pay the patient only.  If Medicare doesn't allow a procedure nothing will pay on behalf of the patient.
> 
> Plan F & G do pay excess charges.  I have hundreds of clients with Plan N (which does not pay excess charges) and not one of my clients has ever had a provider legitimately charge them.
> 
> Medicare really isn't rocket surgery but I find in general that when people do their own research and/or just call a few insurance companies they wind up paying more than necessary.  It may not be easy to find an independent agent that really specializes in Medicare but that's really the best way to do things.  There is no cost to use a professional.
> 
> Rick



I agree.... when my husband and I were first approaching Medicare age we attending a seminar sponsored by a local agent specializing in BC/BS..  This is our first full year on Medicare and so far.. we have been happy with our plans..   

As far as charges go... If a provider agrees to accept Medicare... either an MD or a hospital... they agree to accept what Medicare pays..  They cannot bill a patient for the difference...


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## GreenSky

Lolly said:


> I agree.... when my husband and I were first approaching Medicare age we attending a seminar sponsored by a local agent specializing in BC/BS..  This is our first full year on Medicare and so far.. we have been happy with our plans..
> 
> As far as charges go... If a provider agrees to accept Medicare... either an MD or a hospital... they agree to accept what Medicare pays..  They cannot bill a patient for the difference...



Since we all know that the only difference between companies writing the same letter plan is the price, I hope you not only shopped pricing when you bought your plan, but you do it every year.

BTW, excess charges as rare as they are only apply to Part B.  Hospital charges are Part A and there is no excess charge. 

Rick


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## Lolly

GreenSky said:


> Since we all know that the only difference between companies writing the same letter plan is the price, I hope you not only shopped pricing when you bought your plan, but you do it every year.
> 
> BTW, excess charges as rare as they are only apply to Part B.  Hospital charges are Part A and there is no excess charge.
> 
> Rick



That is correct... because if a Hospital agrees to accept Medicare.. they must accept what Medicare pays... they cannot bill the patient the difference.


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## jujube

A little piece of Medicare supplement history:  I was THE first Medicare supplement department.  The whole department.  Me. I took a part-time job at Blue Cross while I was in college and on my first day, they ushered me into a room with what looked like a zillion boxes of postcards and a whole room full of file cabinets.   Our particular office was setting up the first Medicare supplement plan and so far it had only got as far as people sending back the cards that had been mailed out all over creation and indicating that they were interested in joining.  Blue Cross was the first provider to offer Medicare supplements. 

For the sumptuous sum of (I think) $1.65 an hour, I got to alphabetize and alphabetize and alphabetize.  AND I had to stamp something (I think it was the date) on each one in green ink.  I had a perpetual green right elbow because I kept putting my elbow down on the stamp pad.   I swore then and there I would work hard in college so that I could get a job that didn't include "alphabetizing" on my job description.  I didn't work hard enough and ended up doing a lot of things that weren't _much_ more interesting than alphabetizing. 

When I left the job several months later, there were over 40 people working in the department.  

And now.....I HAVE Blue Cross Medicare supplement.  How's that for karma?  I think my karma ran over my dogma.


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## mathjak107

debodun said:


> 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?



as i just learned last week when i got a bill  , the medicare wellness visit is not a comprehensive exam . they cover a few things but it is mostly a questionnaire and health evaluation  . i went on medicare in october , had my annual exam in october and got a 146 dollar bill because i did not  meet my deductible on the uncovered items in the wellness check .  i have a high deductible f-plan so i have to pay this .

the unfiar part is medicare has no carry over or pro-rating of the deductible. i have a new deductible as of today .  they really should have provisions for those going on in the last 2 or 3 months not to have a full deductible again 60 or 90 days later.

here is what a wellness exam covers , you can see it is not an annual physical exam .

https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html


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## Don M.

The annual "Wellness" exam seems to be little other than an annual "paperwork" update.  Our Humana Advantage plan covers the cost...with only a $20 co-pay, so we usually go in every Spring for it.  I generally use it as a means of scheduling any "specialist" treatment I might require....this year, I have a small cyst developing on my thumb...probably a small bone spur which will require a minor surgery...so I will get that taken care of in March or April...$20 for the doctor co-pay, and probably $50 co-pay for the minor surgery.  My retiree benefits cover the insurance premiums, so our annual out of pocket costs are usually no big deal.


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## mathjak107

yep , i was quite surprised to see a bill , because i thought the wellness check was an exam . as i learned it is not .


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