Medicare and Endocrinologists office billing

I am so angry right now…the facility that my Endocrinologist works out of takes my co-payment every visit, then they bill medicare for payment, accept that payment, (which is their negotiated payment), than the have the audacity to send me a bill for what was left over of the Original Non-medicare charges. I am refusing to pay it because I believe I read someplace that this is a common place practice that some facilities do to patients to get the total ORIGINAL, (what is normally charged for non medicare Patients), amount for the office visit or what have you…can anyone shed some light on this…I always thought that once you pay your co-payment then what ever Medicare pays is what they have to accept as it is what they negotiated for in their contract with Medicare…

Medicare sends me periodic statements through the mail. The statement is called, “Medicare Summary Notice.” In a tabular format there are columns labeled, “Amount Provider Charged,” “Medicare Approved Amount,” “Amount Medicare Paid,” and “Maximum You Will Be Billed.” I don’t ever pay based on the Amount Provider Charged.

Medicare knocks down the original doctor billing to a lower amount, then Medicare pays 80% of that and I pay the “Maximum Amount You Will Be Billed,” the remaining 20%.

If I were you, I would wait until this statement arrives before you pay any additional amount. These statements usually cover three calendar months.

Terry, thanks for that info…Yes I get those statements from Medicare as well…But it’s not what medicare pays that I am upset about. On the bill from the doctors office it tells what Medicare paid, What I paid, (my co-payment), what their medicare contractual adjustment is and what was left over of what their regular office visit cost. This is what I am being billed for. I’ve NEVER been billed by a doctors office for any remaining amounts due because as Medicare explained to me, “the amount of my co-payment, and the amount that medicare pays is all they are entitled to, they should not and CANNOT bill you for any other amount left over…”. This is considered “Double billing”…So my question is can and do Doctors offices make this a practice, As I have heard, to try and get more money out of the patient to cover what their office would normally charge a non-Medicare patient??

It’s my understanding the doctor has contractually agreed with Medicare to accept Medicare’s price for this service. I agree with Medicare’s explanation. Call the doctor’s billing office and get an explanation from them. I don’t think they can do this and it may be illegal. I believe the “Maximum Amount You Will Be Billed” is the bottom line for your entire out of pocket cost for this service on this date.

I’d love to hear the resolution for this. The explanation could be as simple as a new billing office manager does not understand how their billing and Medicare work. Please update when you find out.

Terry, I found out that my situation is called being “balanced billed” and is ILLEGAL if the provider has a contract with Medicare, which the facility I goto does…I will be calling the office of Medicare and Medicaid Services tomorrow and filing a complaint…I have gone back through past bills I have recieved and they have ALL been Balanced Billed…can we say “they are in TROUBLE!!!”

I can’t believe any doctor would willingly cut corners and threaten their long term relationship with Medicare. Even if they didn’t care about Medicare, breaking a law is risky, especially to your financial health.

Maybe you should have a heart to heart with the doctor’s billing office first. You should probably ensure that the doctor is aware of this practice as well. The doctor may be ignorant of billing practices and has fallen prey to a slick-talking billing service. By reaching out to the doctor/billing office first, perhaps you can be made whole more quickly.

Terry, that is true…I usually don’t like to cause waves, so, I will do that and reach out to the billing office first and give them the benefit of the doubt and see if they will correct this “mistake”…I don’t want to ruin it for other Medicare patients and have to have them find another doctor as he is the best in Diabetes care in an 8 county area…and he probably has no idea about how his facility is billing Medicare and his patients…

It is highly UNlikely that the doctor knows this is going on. The overwhelming majority of doctors turn administration over to a staff so they don’t have to be bothered with it. It is actually standard for the left hand (doctor) not to know what the right hand (office) is doing. It’s the rule, not the exception—particularly in clinic situations that are not not solo practices. I can cite numerous examples from personal experience, but I won’t bother except to relate that I once told a doctor about something his front office had done to me and he looked at me as though he’d just been kicked in the head.