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Originally Posted by APovi
MEDICARE Fact or Fiction?
Is there is no way for a patient to know, in advance, if a 'treatment/prescription/therapy' is/will be covered by their Health Insurance?
Our friend got an unexpected invoice, so I called them for her.
I was told by the doctor, Medicare and the insurer that they cannot tell a patient, in advance, if a proposed medical expense is covered.
Apparently your medical provider submits an invoice to Medicare.
They decide which items they will pay.
Your insurer will only pay those charges which exceed what Medicare paid..
What we didn't realize is that, if Medicare says 'We don't cover that at all.' then your Supplemental Insurance doesn't either.
So, even with the best 'F' Supplement you're stuck with an unexpected expense!
Oh well!
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I have never run into this. I have United Health Care J Plan and everything is covered. I have never even heard of a doctor doing procedure which was not covered under the patients existing plan. In fact I have been sitting in Dr. Georges (Cardiologist) waiting room and heard the receptionist telling people their insurance will not cover this, this and this. It certainly does not sound very ethical to do a procedure without first informing the patient of the cost to them.