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Seeing A Physician Who Takes Assignment
- Medicare pays for services on either an assigned or unassigned basis.
- You can reduce your costs by seeing doctors who take assignment.
- A doctor who takes assignment agrees to take the Medicare-approved
amount as payment in full.
- Medicare pays 80 percent of the approved amount.
- You pay 20 percent.
| Doctor Charges |
$150 |
| Medicare Approves |
$125 |
| Medicare pays 80% of $125 which equals |
$100 |
| You pay 20% of $125 |
$ 25 |
Limiting Charge of Procedures
- Doctors and suppliers who do not accept assignment cannot collect
more than the "limiting charge."
- For items or services paid under the fee schedule, the limiting charge
is 115% of the Medicare approved amount.
- To determine if your doctor charged more than allowed, check the Explanation
of Medicare Benefits form.
| Doctor charges |
$150 |
| Medicare approved |
$100 |
| Limiting charge (115% of $100) |
$115 |
| Doctors charge was |
$35 too high |
Elective Surgery Provision
- On unassigned elective surgical claims for more than $500, a doctor
must give certain notices.
- The notice must tell you
- The estimated charge for the procedure and the estimated Medicare
approved amount.
- How much more the doctor's charge is than the Medicare approved
amount and the co-insurance amount.
- The doctor must give the notice before surgery or the doctor cannot
charge more than the Medicare approved amount.
- Elective surgery means you can schedule it in advance, it is not an
emergency, and delay would not result in death or permanent health problems.
Waiver of Liability Provision
- If you did not know Medicare wouldn't pay for a service but the doctor
did and didn't tell you, then you do not have to pay the doctor's fees.
Disclaimer: This information is not legal advice. If you have a legal problem, you should talk to a lawyer and ask for advice about your options.
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