Quote:
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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If you have Government Medicare, the doctors know what's covered and not covered, and they should have informed you. The link someone provided about regarding "Surprise Bills" is the operative issue. They are not allowed. We've had these type bills wiped out before, even with my kids. If you have Medicare Advantage, that is just private insurance with the Medicare name on it, and it has nothing to do with Government Medicare, you have one or the other. In the case of advantage plans, they can be very spotting on what they'll pay us for (I work in oncology). One Advantage plan may pay and the next one won't, even though they're supposed to follow Medicare guidelines. They will usually have things like Local Coverage Determinations (LCDs) for the more expensive procedures. It's not unusual for LCDs to change and not be told until they reject the charge and say, oh there's a new LCD. We always provide an estimated bill, when ask by a patient, although we cannot estimate beyond our own specialty. IMO, go to the Surprise Bill link read it and follow the procedures for your State.