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Old 03-18-2010, 12:59 PM   #5
Reese1
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Join Date: Oct 2006
Location: Ohio
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Quote:
Originally Posted by ARCHIE View Post
One thing we are confused on if the Dr. charges $200 for a visit & Medicare pays $100 if she would be responsible for the difference along with the $20 co-pay.



It is my understanding that a doctor can not bill more than 20% of Medicare
allowance. It's a law.
So if a Doctor charges $200.00 and Medicare allows $100.00 you would be responsible for $20.00. Because the doctor, by law, cannot bill more than
20%. A co-pay is a co-pay paid at time of service. In NY anyhow.

Hence the additional insurance Medicare recipients take out to cover
the additional 20%.
Ok, I called the insurance company that has the plan for her Medicare Advantage plan & asked them.
Her co-pay for a primary care Dr. is $20 and that is ALL they can charge her. It's an HMO and she only has to pay the co-pay!
She pays $15 for lab/20% for certain radiology, etc..

Now if she had the original Medicare she would pay 20% of whatever they charge unless she had a Medicare supplement to cover the gap!

So confusing!!

We are trying to weigh now her total prescription + co-pay costs + diagnostic costs to see if it's less expensive to switch off the Advantage plan!
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Last edited by Reese1; 03-18-2010 at 12:59 PM. Reason: .
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