Medicare Provider Opt Out quesiton?

Question

If a provider has opt out of medicare, but the patient files with medicare, does anyone know the verbiage of what the EOB to the member would state regarding the claim?

Answer 1

I'm not sure what the exact verbiage would be but Medicare will not pay anything if you receive care from a provider that has opted out of Medicare. In fact, it is considered fraud to file a claim but Medicare seldom does anything about it. If you have a Medicare Supplement or a Medicare Advantage plan they won't pay either.