Question about Medicare?

Question

My 69-year old aunt went to the doctor to have a mole removed from her shoulder.

She has Medicare part B without any supplemental insurance. Her out of pocket is 20% of what Medicare allows.

When we went to check out, the office manager told her that she owed the doctor $350 for the mole removal. Outrageous, said my aunt.

The office manager told her that the doctor's fees for the procedure was $1,750.00 and that she could not leave before she paid her 20%. We asked for a statement and were told that they do not give or send out statements. She had to pay the $350 and that Medicare would pay the other 80 percent.

Not being complete idiots we went home and contacted Medicare who told us that the conduct of the office manager was highly unethical ($1,750.00 to remove a mole!!).

Has anyone else run into this kind of problem?

Answer 1

Medicare has a set allowed amount for any procedure, and that's what your aunt would have been responsible for...not 20% of whatever the doctor decided to charge.

And yes, the doctor's office should have billed Medicare first then sent a statement later.

I hope your aunt didn't actually pay before she left...she should not have been liable for that amount, even after Medicare processed the claim.  (Medicare's allowed amount for a mole removal is almost certainly significantly less than $1,750!)

Answer 2

I would get another doctor. If they don't provide you with a statement it sounds like they have something to hide.

On the surface it sounds like fraud. Doctors must code each procedure and Medicare pays a set amount for each code. If the doctor accepts assignment he agrees to accept the amount Medicare pays plus your 20%. If he doesn't accept assignment he can charge up to 15% more for a procedure which is the patients' responsibility in addition to their 20%. Without knowing all of the facts I'd guess the doctor was going to do other procedures, such as running tests to make sure the mole wasn't cancerous, or at least bill Medicare for those tests. The first thing you should ask of any doctor is "do you accept assignment?"

Your aunt should also look into getting a Medicare Advantage plan. These plans have a low or even a $0 premium in many places and any procedures done will have a small co-pay. She needs to visit a local agent that works with all the major companies in her area. The agent can find the best plan for her and there is no extra charge for the service.