Emeritus
Full time employment: Posting here.
- Joined
- Feb 27, 2009
- Messages
- 886
I doubt that I understand the question. Insurance won't pay all possible medical bills -- right? If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it. If I have to pay, I suppose you might say my supplement was not totally suitable -- is that what you're getting at?
the law is very clear
Balance billing of medicare patients by participating physicians is unlawful
Ill put it in again
"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services or supplies provided to a Medicare beneficiary, except when Medicare is the secondary insurer. When Medicare is the secondary insurer, the health care practitioner may pursue full reimbursement under the terms and conditions of the primary insurer, but the Medicare beneficiary cannot be balance billed above the Medicare reimbursement rate for a Medicare-covered service or supply. "Balance billing" does not include charging or collecting deductibles or co-insurance required by the program.
Medicare Balance Billing Main Page
So Participating physicians can only collect the deductible or coinsurance required by the program, which is normally paid by the supplement.
Medicare isn't like private insurance. Its a statutory program enforced by the criminal law. If they take money form medicare and balance bill you it may be a crime
42 U.S.C. § 1320s-7b(e), Illegal Medicare Balance Billing,
Nonparticipating physicians are not covered by this section but have other limits