Quote:
Originally Posted by Dan9871
BTW GE, it's great having your "from in the trenches" comments on how the health care system works in practice.
I just want to make sure I understand what you are saying about places that don't accept Medicare.. If I go to a doctor or facility that does not accept medicare there is no way for me to use medicare to supplement what I pay that doctor. Even if that doctor sends paperwork to my medicare supplement insurance company and the insurance company sends the check to me and not the doctor. It's medicare all the way or no medicare at all.
Thanks again for all your explanations and clarifications.
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Basically. If you go to a provider who does not participate in Medicare, there is no limit to what he/she can charge, other than market forces. If they submit the bill to insurance (and not stick you with the paperwork), the check will come directly to you, and so it does , in effect, supplement what you paid the provider. But there may be a huge difference between the charges and what Medicare pays, and that difference is out of your pocket.
When they started with the "participating provider' program back in the 80's, one incentive was that the provider got paid directly from Medicare, which eliminated a lot of collection problems. You would be surprised (maybe not) how many people would come to an office visit, and when they got the Medicare check go out and have a nice meal instead of paying for the service they utilized. Most of them wouldn't even get indigestion over it.
These days, the paper is eliminated from the paperwork. The provider electronically submits charges to their Medicare intermediary carrier, and the payment is auto deposited into their bank account, same with Medicare supplements and secondary insurance. The only "human" work is matching the payments to the charges (unless you are VERY trusting of government efficiency). With new EMR systems, the charge codes are entered by the provider along with the progress note at the time of service, so no one has to "punch" in the days charges. Not so easy if the patient gets stuck submitting it.