Thanks again.: I was not able to stump you!...….so I and two of my friends went hunting last week and grabbed a hotel for a night and the manager told us the room cost $30. We each handed him a $10 bill and went to the room.. Apparently the hotel manager realized he made a mistake and that the room was only$25...So he gave his son, five $1 bills and told him to come knock on our door and give us the change. When he knocked on the door and handed me the five $1 bills, I kept one and gave each of my friends $1 and told the kid to keep the remaining $2 for a tip. Thus, each of us spent $9 ( the original $10 less the $1 we got back). $9 time 3 is $27...The kid has $2 for a tip, which totals $29 ($27+$2). Where did the other $1 go ?
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Is Plan K a good choice ?
- Thread starter shug23
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The 3 of you spent $27 on the room ($25) and tip ($2). The $2 tip is being mistakenly counted twice. Find a better motel next time.
hey...if you are still out there...….what happens if one uses a provider that is not on the Medicare.gov website ? Lets say the procedure costs $200 and the approved Medicare charge is $100......I believe the provider cannot bill Medicare but that I would have to submit the bill for reimbursement and likely on the hook for the excess over the Medicare approved amount. but could Medicare simply deny the entire claim ? and if so, why ?....are there any statistics on denials ?
Please refer back to the last paragraph of post #10. If the provider is not on the Medicare.gov website, there is no Medicare involvement. The patient and provider have negotiated payment details prior to treatment. There is no Medicare approved charge since the service is not sent to Medicare by the provider or the patient. Note that while you may not have found the provider on the website, the provider may still be listed. For example, you may be searching for John Smith, MD and he is listed as Johnathan Smith, MD. It's best to call the provider and ask if they bill Medicare and do they accept Medicare assignment.
The 4% of non-participating providers who can balance bill the additional 15% will submit the charges to Medicare. For non-participating providers, Medicare sends payment to you, not the provider. The link below outlines the maximum amount the provider can bill ($109.25) and the payment calculation for non-participating providers (115% of 95%). Medicare cannot deny a claim simply because it came from a non-participating provider. Some states prohibit Medicare balance billing.
Mayo Clinic Non-Participating: https://www.mayoclinic.org/documents/mayo-clinic-medicare-and-you/doc-20078770