Thinking Im being overcharged for office visits – Medicare

by Linda

I recently moved to new location in Michigan. I’ve been seeing a new family doctor . They are charging me $186.00 a visit. When I asked about it, the nurse told me the price was $65.00 for first visit and $50.00 after that.

I asked why I was being charged so much more she said because I had Medicare and Medicaid (spend down of 800.00 a month). She said I’d be better off paying cash????

I just don’t understand why I am being billed so much for office visits. The visits are for prescription refills but they say I have to have another reason to be there so they can write it up differently????? This just doesn’t sound right to me.

I really think I’m being overcharged for my insurance. Could you possibly explain this to me.

Thank you

Thanks for your question Linda. I’ll attempt to answer.

I would first make sure that the doctor you are seeing “Accepts Assignment” of Medicare.

What this means is that your doctor agrees to accept the Medicare-approved amount as full payment for covered services. This is required by law if they do accept assignment.

When your doctor does accept assignment, it limits your out-of-pocket costs as they agree to charge you only the allowed deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay.

A non-participating provider doesn’t have an agreement with Medicare/Medicaid. However they can still accept assignment – they just may require you to pay the entire charge at the time of service. They can charge you more than the Medicare approved amount, but only up to 15%.

From what you have described it sounds like your doctor may be a non-participating provider. You may want to ask and if so change to a participating doctor that accepts assignment.

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