[billbob]

I went to visit my daughter in Union Kentucky and got Covid. She took me to St. Elizabeth Urgent Care. The girl said they don't take Medicare unless from the tri state area, plus it was $280 just to go back for care and any additional treatment would be billed via credit card. I said no way and went to St. Elizabeth ER and they took Medicare and I was through there in 1/2 hour. I never heard of not taking Medicare - I thought it was a federal program. Thoughts?

[dewilson58]

Depends on what type of Medicare you have.

While most urgent care centers accept Medicare, they can choose to accept or deny any health insurance, including Medicare. If an urgent care center doesn't accept Medicare, they must still treat patients with Medicare, but they may require full payment up front. Patients can then file a reimbursement claim with Medicare after receiving paperwork from the urgent care center.

[OrangeBlossomBaby]

Originally Posted by billbob

I went to visit my daughter in Union Kentucky and got Covid. She took me to St. Elizabeth Urgent Care. The girl said they don't take Medicare unless from the tri state area, plus it was $280 just to go back for care and any additional treatment would be billed via credit card. I said no way and went to St. Elizabeth ER and they took Medicare and I was through there in 1/2 hour. I never heard of not taking Medicare - I thought it was a federal program. Thoughts?

What does it say in the medicare documentation you received and agreed to, when you signed up for it?

[villagetinker]

Medicare is generally much more widely accepted, but not universal, just look at the Villages health System which only accepts 3 or 4 Medicare ADVANTAGE plans. As noted above it may depend on what type of Medicare coverage you have. We had to leave Medicare ADVANTAGE plans due to problems with doctors not accepting these plans, this is their choice, and they all accepted traditional Medicare.

[Keefelane66]

I did a search these are the plans that are accepted at St. Elizabeth Urgent Care.


Commercial

Aetna
Aetna Whole Health
Ambetter CCCWAExchange
BridgeSpan (RealValue)
Cigna
Coventry/First Health
First Choice Health Network
Humana/ChoiceCare
Kaiser Permanente Core
Kaiser Permanente CoreSelect
Kaiser Permanente Virtual Plus
Kaiser Permanente Access PPO
Kaiser Permanente Summit PPO
LifeWise
LifeWise Primary
LifeWise Preferred
Molina Marketplace
Multiplan/PHCS
Premera Blue Cross
Regence Blue Shield
Regence VMFH AHN
Regence Individual & Family Network
Uniform Medical Plan (UMP)
UMP Plus - PSHVN
United Healthcare (UHC)
UHC Doctors Plan
UHC Nexus ACO
UHC Navigate
UHC Charter
Medicare Advantage

Aetna Medicare
Humana
Kaiser Permanente
Molina Medicare Complete
Premera Blue Cross
Regence BlueAdvantage HMO
Regence MedAdvantage PPO
UHC AARP Medicare Advantage
UnitedHealthcare SNP
Managed Medicaid

Amerigroup
Coordinated Care
Molina
United Healthcare
Government

Labor & Industries
Medicaid
Medicare Railroad
Medicare
HNFS TRICARE
TriWest (VA)
USFHP - PacMed

[tophcfa]

Do you have an Advantage or Supplemental plan? Some Advantage plans have a limited network. With the exception of the Villages Health system, Supplemental plans are pretty much accepted anywhere in the country.

[MplsPete]

Originally Posted by villagetinker

Medicare is generally much more widely accepted, but not universal, just look at the Villages health System which only accepts 3 or 4 Medicare ADVANTAGE plans. As noted above it may depend on what type of Medicare coverage you have. We had to leave Medicare ADVANTAGE plans due to problems with doctors not accepting these plans, this is their choice, and they all accepted traditional Medicare.

You left ADVANTAGE, I presume you reverted to original, basic Medicare (not a supplement?) I'm curious, what is the procedure when you go to a physician. I suppose you present your Medicare card, then what? Do you get a bill? Do you have to send that to Medicare? Is it a smooth process, or cumbersome? Do you pay before Medicare reimburses you? Do all clinics accept this? C'mon, enquiring minds want to know . . .

[retiredguy123]

Originally Posted by MplsPete

You left ADVANTAGE, I presume you reverted to original, basic Medicare (not a supplement?) I'm curious, what is the procedure when you go to a physician. I suppose you present your Medicare card, then what? Do you get a bill? Do you have to send that to Medicare? Is it a smooth process, or cumbersome? Do you pay before Medicare reimburses you? Do all clinics accept this? C'mon, enquiring minds want to know . . .

You don't send a bill to Medicare, and Medicare doesn't reimburse you. The provider bills Medicare and the provider is paid directly from Medicare. If you don't have a Medicare supplement, then you are responsible for a 20 percent coinsurance payment.

[Caymus]

Originally Posted by MplsPete

You left ADVANTAGE, I presume you reverted to original, basic Medicare (not a supplement?) I'm curious, what is the procedure when you go to a physician. I suppose you present your Medicare card, then what? Do you get a bill? Do you have to send that to Medicare? Is it a smooth process, or cumbersome? Do you pay before Medicare reimburses you? Do all clinics accept this? C'mon, enquiring minds want to know . . .

Actually, I present 3 cards (Medicare, Supplement Plan, and Part D -drugs).

[MightyDog]

Originally Posted by billbob

I went to visit my daughter in Union Kentucky and got Covid. She took me to St. Elizabeth Urgent Care. The girl said they don't take Medicare unless from the tri state area, plus it was $280 just to go back for care and any additional treatment would be billed via credit card. I said no way and went to St. Elizabeth ER and they took Medicare and I was through there in 1/2 hour. I never heard of not taking Medicare - I thought it was a federal program. Thoughts?

Do you mind if I ask why you went to an urgent/emergency care facility for Covid?

Also, what did they prescribe to you? Thanks...

[BrianL99]

I think people on this thread are getting confused (or maybe I'm confused, I suppose).

Medicare is Medicare. Not all medical facilities take it. The ones that don't, are likely not "approved" by Medicare or simply don't want to do work at approved Medicare rates.

Medicare Supplemental or Advantage, is an entirely other type of medical coverage. Again, medical facilities can decide what Insurances they'll accept or not accept.

Facilities can take Medicare, but not take your Supplemental or Advantage Plan.


Does your provider accept Medicare as full payment? | Medicare

[JMintzer]

Originally Posted by retiredguy123

You don't send a bill to Medicare, and Medicare doesn't reimburse you. The provider bills Medicare and the provider is paid directly from Medicare. If you don't have a Medicare supplement, then you are responsible for a 20 percent coinsurance payment.

Close, but no cigar...

Yes, Medicare has to file the paperwork for you, but the Drs DO NOT have to accept assignment (aka payment) from Medicare. They can require you pay them and then you'll get paid by Medicare. There is a limit as to what they can charge you. I believe it's 110-115% of the Medicare allowable...

If you have your Medigap set up properly, Medicare will automatically forward the claim to your secondary insurance for co-insurance payment...

[biker1]

No, I don’t believe that is correct. If a provider accepts Medicare (regular, original Medicare) then they also have to accept your supplemental plan (aka “Medigap”, one of the “lettered” plans such a F, G, N, etc.). Please note that I am not saying anything about Medicare Advantage, which is a different animal.

Originally Posted by BrianL99

I think people on this thread are getting confused (or maybe I'm confused, I suppose).

Medicare is Medicare. Not all medical facilities take it. The ones that don't, are likely not "approved" by Medicare or simply don't want to do work at approved Medicare rates.

Medicare Supplemental or Advantage, is an entirely other type of medical coverage. Again, medical facilities can decide what Insurances they'll accept or not accept.

Facilities can take Medicare, but not take your Supplemental or Advantage Plan.


Does your provider accept Medicare as full payment? | Medicare

[scubawva]

Medicare is a federal program. Providers are not required to accept Medicare.

Only ~ 5% of providers in the US do not accept Medicare - the largest group by far in that ~5 % is right here - The Villages Health System.

Those of us who kept Medicare (most also then choose to buy a supplement) can’t use TVHS for PCP, we can for most specialist.

TVHS accepts only Advantage plans (which is not original Medicare) for PCP.

What would have happened had you stayed? You pay and then get reimbursed through your carrier?

Hope you’re feeling better, to go to an ER for COVID you were deathly ill, most don’t get too sick any longer. Speedy recovery.

[BrianL99]

Originally Posted by biker1

No, I don’t believe that is correct. If a provider accepts Medicare (regular, original Medicare) then they also have to accept your supplemental plan (aka “Medigap”, one of the “lettered” plans such a F, G, N, etc.). Please note that I am not saying anything about Medicare Advantage, which is a different animal.

According to this, you're right. If they take Medicare, they have to accept your Supplemental Insurance, also.

Do All Doctors Accept Medicare? - MedicareGuide.com