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Periodic Contributor

Quick question about the 198.00 deductible??

Thanks so much for the responses to my last question! We are happy (I think?) with our choices. We took traditional medicare with a G plan from Mutual of Omaha. We had our first claim and after some difficulty making the people at Medicare understand that we no longer have primary insurance at my husband's work, they are paying.

 

Another quick question... (remember there are NO silly questions!) How do we pay the 198.00 deductible? Is it taken from our SS checks as our Medicare payment is, or will individual practitioners bill us? This is our first claim and we are trying to learn to navigate this crazy system! 

 

Thank you in advance! (I'm sure you will laugh because I'm sure the answer is so obvious to you who have been there but I have "googled" and I'm at a loss)!

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Bronze Conversationalist

@VivianR375175  you may not want to pay for ANY services until AFTER Medicare is billed.

 

When Medicare adjudicates the claim they first determine if the item is a covered service. If it is not, the claim is denied and you don't owe it unless you signed an ABN form.

 

You should not pay "as billed" until after adjudication. When approved the claim is repriced to match Medicare's fee schedule. This is always less than the gross billed amount.

 

The above applies whether you have satisfied your deductible or not.

 

Medicare will never bill you for a deductible. That will come from the provider.


Bark less. Wag more.
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Regular Contributor

Your doctor will send the bill to Medicare. Medicare will pay all but the deductible to your provider. Your provider will then bill you for the deductible. If the doctor asks you to pay the deductible at the time of service, tell them to bill Medicare. 

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Honored Social Butterfly

@cougarlinz 

There are always different scenarios so it is always best for the patient  to know before refusing to pay the deductible - all or part - when a provider ask. 

Medicare is like any other insurance plan, you have to understand your (own) coverage and all the various specifics.

Medicare, as the insurer, uses many generic terms like "usually", "may" so as not to get pigeon-holed into any "always-type" answers because it just always depends on the surrounding circumstances.

 

Medicare.gov - Lower Cost With Assignment 

Here's what happens if your doctor, provider, or supplier accepts assignment:

  • Your out-of-pocket costs may be less.
  • They agree to charge you only the Medicare Deductible and Coinsurance  amount and usually wait for Medicare to pay its share before asking you to pay your share.
  • They have to submit your Claim  directly to Medicare and can't charge you for submitting the claim.If your doctor, provider, or supplier doesn't accept assignment

If your doctor, provider, or supplier doesn't accept assignment

Non-participating providers haven't signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services. These providers are called "non-participating."

Here's what happens if your doctor, provider, or supplier doesn't accept assignment:

  • You might have to pay the entire charge at the time of service. Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you.
  • They can't charge you for submitting a claim. If they don't submit the Medicare claim once you ask them to, call 1‑800‑MEDICARE.

more at the link ~

 

It's Always Something . . . . Roseanna Roseannadanna
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Honored Social Butterfly

I have never seen a bill for the Part B deductible from Medicare -

What they do is deduct the amount of the deductible from what is paid to or suppose to be paid to the doctor.  Then if there is no added supplemental (Medigap) coverage that covers it, the doctor's office will then bill the patient for the amount of the deductible still outstanding - all or part.

This can all be followed very easily on the Medicare Summary Notice - Part B 

This pdf describes the whole form - I am only giving a screen shot of page 1 - notice Item 3️⃣ describes the deductible.

 

Screenshot_2020-10-21 Medicare Summary Notice Part B - summarynoticeb pdf(2).png

 

It's Always Something . . . . Roseanna Roseannadanna
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Regular Contributor

I edited my response for clarification. 

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