Medicare Deductible Overpayment?

[marko]

Academic question:

The Part B deductible this year is $240.

Let's say you visited a bunch of doctors in a very short period of time--maybe all in one day-- and, not having met your deductible, are charged and you pay each time.

The total charges exceed the deductible but each provider hasn't uploaded the charges yet; some take days to do so. (I'm assuming that somewhere on the provider's computer there's a list of whether the deductible has/hasn't been met)

Do you get a refund or is it 'tough luck'? Or is this a good time to not "pay when services are rendered"?

 

[audreyh1]

You don’t pay anything until you get your EOB.

A lot of doctors taking Medicare don’t require payment up front, so it might be a non-issue.

I would perhaps pay the first if asked, then later when asked have you met your deductible say you might have and wait for the EOB.

You can go back to the provider and have them reimburse. We were offered that option once.

 

[REWahoo]

You'll get a refund but you might have to work at it and it will likely be a few months before you see your money.

We were faced with that situation early this year when DW had appointments with three different doctors the last week in January. Every visit expected her to pay her $240 deductible up front. Our solution was to make sure we got a receipt from the first dr for the $240 payment, then present that at the other two appointments to show she had met her deductible in full for the year. That worked fine at one clinic but another gave her a little trouble until a phone call to a supervisor.

 

[Dash man]

In my experience I’ve never been asked to pay upfront since I’ve been on Medicare.

 

[audreyh1]

You'll get a refund but you might have to work at it and it will likely be a few months before you see your money.

We were faced with that situation early this year when DW had appointments with three different doctors the last week in January. Every visit expected her to pay her $240 deductible up front. Our solution was to make sure we got a receipt from the first dr for the $240 payment, then present that at the other two appointments to show she had met her deductible in full for the year. That worked fine at one clinic but another gave her a little trouble until a phone call to a supervisor.

Good tip about having the receipt handy.

In my experience I’ve never been asked to pay upfront since I’ve been on Medicare.

The only place that asked last year was the eye doctor practice. He was there to see an ophthalmologist.

 

[CRLLS]

In my experience I’ve never been asked to pay upfront since I’ve been on Medicare.

I'm on traditional Medicare and Plan G. I have only been "asked" to pay upfront 1 time in 6 years. I am pretty sure I have posted here about it. It was an urgent care facility. They already had my insurance ID's, They asked me for payment of the office visit upfront, and said their policy was to collect now and if there was any amount due me, they would refund it to me. I told them that my policy is to wait for everything to work thru the system and once that is done and every entity agrees, I will pay whatever is due. How do we resolve our differences? They did not push back harder and I was seen by the medical staff.

I can't say that all places will act accordingly. It is Medicare's policy I believe.

 

[Dash man]

I'm on traditional Medicare and Plan G. I have only been "asked" to pay upfront 1 time in 6 years. I am pretty sure I have posted here about it. It was an urgent care facility

Last year I visited an Urgent Care facility here in Florida. After the visit I offered to pay my Plan N $20 copay that I was certain would be charged. They told me to wait until after the Medicare and UHC paperwork went through and they’d bill me. This was in January. I called again in March after I got my statements from Medicare and UHC. The Urgent Care company hadn’t processed it yet. I finally got a bill in June and paid. I hadn’t realized how bad my OCD about paying bills had gotten until then!

 

[lawman]

You don’t pay anything until you get your EOB.

A lot of doctors taking Medicare don’t require payment up front, so it might be a non-issue.

I would perhaps pay the first if asked, then later when asked have you met your deductible say you might have and wait for the EOB.

You can go back to the provider and have them reimburse. We were offered that option once.

The problem is that $240.00 you pay the first provider is paid based on the amount charged which is usually a lot higher than amount approved? I have paid at time of service once or twice but never without a lot of protest..

 

[CRLLS]

The problem is that $240.00 you pay the first provider is paid based on the amount charged which is usually a lot higher than amount approved? I have paid at time of service once or twice but never without a lot of protest..

Not true. First, Medicare negotiates their contracted price. That is what your annual deduction is based on, not the provider's billed amount. There is no way that a provider knows, at the time of service, whether you have already met that deductible. Medicare will tell you what you "may" have to pay. Then, and only then, pay it. But only after the supplement provider does their thing.

I once had it happen where after Medicare was done with their thing and notified both the supplement provider AND the provider, the provider made corrections to the service codes and they all went thru another round of approvals/agreements.

 

[CardsFan]

In my experience I’ve never been asked to pay upfront since I’ve been on Medicare.

That has been my experience as well (Medicare with plan G), but so far I have only gone to docs that I have been using for years.

I can sympathize with the Urgent care facilities, since they are probably the most likely to get stiffed, but I would still push back.

 

[athena53]

You'll get a refund but you might have to work at it and it will likely be a few months before you see your money.

We were faced with that situation early this year when DW had appointments with three different doctors the last week in January. Every visit expected her to pay her $240 deductible up front. Our solution was to make sure we got a receipt from the first dr for the $240 payment, then present that at the other two appointments to show she had met her deductible in full for the year. That worked fine at one clinic but another gave her a little trouble until a phone call to a supervisor.

This. My friend who answers calls from Medicare beneficiaries with questions sees this frequently. I can't remember paying up front for anything except maybe the occasional Urgent Care visit but I like the idea of keeping the receipt.

 

[marko]

OP here. Today my question was answered in real life...no longer an academic question.

I just got a bill for $160 for physical therapy. According to them, I had not reached my $240 deductible.

What happened (I think) is that my doctor, who I had been paying was very slow in reporting my charges to Medicare. So while I actually had met my deductible, the PT people had no way of knowing.

Actually I'm not sure how this happened but here I am.

So it can happen. Regardless, I paid the bill, have no intention of spending my time chasing $160.

FWIW

 

[badatmath]

I would have asked the PT to refigure the bill to account for it but I guess I am not as nice as you! In fact I just did this (not on medicare though).
They simply verified what I said and adjusted. No hassle.

 

[marko]

I would have asked the PT to refigure the bill to account for it but I guess I am not as nice as you! In fact I just did this (not on medicare though).
They simply verified what I said and adjusted. No hassle.

I did ask if they could resubmit the claim and they refused. Moving on.