Page 47 - May 2021 Issue.indd

if they accept Medicare Assignment! Those with supplemental Insurance Plans. Try asking a doctor’s office, even the billing
insurance must provide both your Medicare and Supplemental department, to project what a procedure will cost. They have no

insurance cards when signing in for care, or accepting DME idea and will tell you it has to be processed through insurance
equipment, to ensure that the billing will cycle through both before knowing what the cost will be. It all depends on the
Medicare and Supplemental payers. Th e final bill should refl ect agreed upon amount between the “health care plans” and the

any payments made and state who they were made by. Th e system, practitioner, or facility who are providing the service

resulting balances should reflect what is left of the part “B” or procedure. Then, depending on the deal made with diff erent

annual deductible and/or 20% of the final Medicare agreed insurance companies, diff erent patients with diff erent plans

cost. Therefore, Original Medicare beneficiaries should never pay different amounts out of pocket for the same services.

pay upfront for Medicare eligible services. This is where it comes down to what kind of coverage one has

and explains why people hold their heads in their hands over
Note that chiropractic services are not considered medically
deductibles and out of pocket maximums.
necessary therapy by Medicare. Very rarely there are one or two
extremely specific chiropractic services covered by Medicare, “Joe’s” plan with insurance company A establishes the set

but as a rule it does not pay for any of these services. Patients amount of $20 copay upfront, whereas “Jane’s” plan with
must pay for those services fully out of pocket and should company B establishes a $40 copay upfront. Both are seen by
expect any bills submitted to Medicare to be denied. No amount the same doctor for the same reason but aft er billing/coding
of appeals will result in this service being covered. Contact is completed and the insurance companies have paid the
Medicare to verify any possible coverage before beginning agreed upon amount for the service, these two patients end up
chiropractic services. paying diff erent amounts out of pocket to the doctor for the
same service. This is due to the diff erent coverage the policy

To sum up, part “B” covers 80% of the Medicare approved

holders have plus the different deductibles and out of pocket
amount the supplier agrees to accept. This is the reduced

maximums established by different plans. Nothing is cut and
fee amount they agree to charge you for the service or item.
dry about cost of care anymore.
Beneficiaries are responsible to pay 20% of the Medicare
approved amount after the $201 “B” deductible is met. If Cost can also come down to how a procedure is coded for billing
one has supplemental insurance the insurance is responsible of individual services. Whether you are covered by Original
for paying that 20% coinsurance. Depending on the type
of supplemental plan one has, there may be a copay when
signing in for services. Always read your Medicare Statement
to ensure that you are responsible for only 20% of the lowest Senior Homecare by Angels

price available to you. Read carefully to make sure you are being Bathing Assistance • Dressing Assistance • Grooming
billed only for services you received. Assistance with Walking • Medication Reminders
Errands • Shopping • Light Housekeeping
Reading your statement also protects Medicare from the Meal Preparation • Friendly Companionship
millions of dollars spent on deliberate fraudulent billing
Flexible Hourly Care • Respite Care for Families
and coding errors for both the quarterly “B” billing and your
prescription drug plan monthly statements. Sort through the
The Most Recognized and Respected Name in Senior Home Care
extra-legal mumbo jumbo of paperwork in your snail mail
statements and find the pages with the important billing
America’s Choice in Homecare
information to read the bottom line! Keep only what is
important about specific billing in a binder or folder for future

reference if necessary, then shred the rest so you are not bogged
down with useless paper.
One way to eliminate all the extra paper in your statements
is to establish an account on www.medicare.gov and enroll in
paperless statements. Online statements will come monthly,
which keeps you up to date on how you are being charged
and helps prevent errors from compounding. You can scroll We’re here for YOU!
through all the CYA notifications from CMS that are the bulk Available 24 hours a day,

7 days a week
of these statements and get to the pages that actually present
your billing information. Create a file folder on your desktop

for easy access, reduce your paper clutter, and save some trees! 2
In today’s world of insurance compensated medicine, providers’ Locations
fees across the board are compensated diff erently depending 2 2 1 G
221 Glenwood Ave, Easton • 443-746-0494
on what insurance patients have. Fees are dependent on the 106B Williamsport Circle, Salisbury • 443-210-2007
deals made between Health Care Systems and diff erent Health
visitingangels.com/mideasternshore
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