However, I have a couple of cases where the total amount the provider is getting is less than the "Medicare Approved Amount" and I'm wondering why. I'm not concerned about my payments. I just want to understand my Medicare Summary Notices and what the phrase Medicare Approved Amount means.

Here are the details from the MSNs on two cases. (Let me know if you want me to attach all or part of the MSNs.)

First case, visit in a doctor's office.

Service Approved? Yes

Amount Provider Charged: $72.00

Medicare Approved Amount: $69.48

Amount Medicare Paid: $54.47 (78.4% of approved amount)

Maximum You May Be Billed: $13.90 (20% of approved amount)

Second case, physical therapy at an outpatient clinic associated with a hospital.

Service Approved? Yes

Amount Facility Charged: $143.66

Medicare Approved Amount: $143.66

Amount Medicare Paid: $42.35 (29.5% of approved amount)

Maximum You May be Billed: $10.80 (7.5% of approved amount)

Note that of the total amount paid to the provider (42.35+10.80), my part was approximately, but not exactly 20%.

I have some additional hospital outpatient MSNs simlar to the one above with a large difference between the Medicare Approved Amount and the actual amount paid. Howevr, in these cases, my part was exactly 20% of the total paid.

I recall reading that the 80/20 division does not necessarily apply in hospital outpatient clinics. However, I still don't understand what Medicare Approved Amount means.

Many thanks for any insights you can give me.

- Alan