The Issue Of Excess Charges

Original Medicare Policies are aimed at making medical care more affordable. However, there are doctors that don’t accept the Medicare service quota as their full payment and bill you a little extra in the form of an “excessive charge”. This is an explanation of how the charges come up and the best way to avoid paying outrageous medical bills.

Original Medicare Part B Excess Charges

A Medicare coverage comes with a list of pre-approved rates for medical procedures. These are the charges that are considered a fair remuneration for services rendered like visits from the doctor and medical tests. For a healthcare provider, accepting a “Medicare assignment” is the term used for accepting these default payment rates and directly billing your Medicare Carrier.

If I need to have a test conducted, and my healthcare provider accepts the Medicare assignment, then they will only bill me the default rate. That is, if the rate is $2000, the fee I am charged will never exceed this amount. My Medicare will pay the 80% and have me co-pay the remaining 20% and any other deductibles that I am yet to meet.

On the other hand, if the healthcare provider views this sum as inadequate, then they are allowed to charge me up to 15% more than the default rate. This extra is what is called the excess charges. So, if I go to a provider that doesn’t take default fees, they can charge me up to $130 extra compared to a doctor that accepts Medicare agreement. For people covered by Original Medicare only, then the excessive charge also falls upon them in addition to the other charges not covered by your policy.

Though these charges are uncommon, they are still a probability that you may incur them. The only states where excess charges are banned are Rhode Island, New York, Connecticut, Ohio, Minnesota, Massachusetts and Pennsylvania. These states are covered by the Medicare Overcharge Measure law that prohibits it.

Avoiding Excess Charges

Always picking healthcare providers that accept Medicare Assignment is not a practical scenario. In reality, you may want to go with the best available specialist, a trusted doctor recommended by a good friend or a family doctor that you know at a personal level. Other times, no matter how careful you are in the selection of healthcare providers, the charges just creep up on you. They may come from sources not accounted for like the anesthesiologist added to your surgery team, or the consultant that takes a second look at your x-rays.

In order to see the doctor that you need and get the healthcare that you deserve without having to pay hefty out of pocket costs, it is always advisable that you get yourself some Medicare Supplement Plans 2019. These plans, also known as Medigap, serve the purpose of covering your excess charges in full whenever you are treated under the cover of your Original Medicare. For those with the Medicare Part B, Medigap Plan F and Plan G are your best alternatives as they cover you up to 100% of your excess charges, copays, and coinsurances, meaning that you incur nothing for your healthcare.