Medigap & Excess Part B Charges

[yorkriver1]

Recently heard a story at a training about the possibility of some hefty Medicare Part B excess charges for those who choose Medigap plans other than F or G.
Any experience with how to assure that the providers involved in, say, a surgery are not going to apply excess charges? We are in the similar situation to finding a chain of providers that are "in network" in a PPO, HMO, network PFFS scenario in MAPD.

How to describe the relative risk to client is a question. The example given at the workshop is surely a less frequent situation, a very expensive hospitalization/surgery where the bills were over $100k. Good example of how Part B excess could run into thousands, however.

High deductible F avoids this, too, so seems both better and less costly than K,L or N.

Thanks!

 

[midwestbroker]

The following states do not allow providers to charge Part B excess:

Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island and Vermont

In the years I have been selling Medicare plans, I have never had an issue with Part B excess charges. Sure, a provider could charge them, but then you are getting into the scare tactics of selling supplements. If there is a client who is worried about it, call their provider and ask the billing department if they charge them.

 

[Chazm]

What Midwest said. It's a scare tactic if you're trying to sell against plan N. I have seen it once and it was about $40.
I don't worry about it with UHC because a client can switch plans without any health questions.

 

[G.Gordon]

Here's the way I explain the minimal issue with Excess Benefits.

1. It is a 9.25% mark up on the Medicare approved amount, what the doctor actually charges is of no consideration when predicting what will get paid.
2. Say a doctor wants to charge $5000, Medicare approved $1000, then that benefit will only pay $92.50. "If" that provider charges excess charges then it applies, and I go on to explain this is not something you are surprised about, legally they have to tell you this up front, you sign that you were told, etc.
*This is where some agents will say it pays the difference or $4000, bullcrap!
3. I also explain the difference between the three types of providers 99.9999999% of my clients run into. Most providers they run into accept Medicare assignment, with these this benefit is a moot point, others like Mayo will accept Medicare, but do not accept assignment so they can charge the excess benefit and they are satisfied with that amount as payment in full, others that don't accept Medicare assignment and want the full billed charges will assist you in billing Medicare, will even cash the check your secondary pays for this benefit, then they expect you to pay the balance.

Refer back to the above example. Locally we have a bariatric weight loss center that charges $4800 for the banding procedure. With this clinic they have to sign several documents saying you will be responsible for the entire balance. They fully explain and disclose that Medicare approves $990, if they have F or G they get an extra benefit of ~$90, then they have to whip out a chunk of cash, credit card, or what ever to pay the balance UP FRONT.

I only go through this IF it is brought up because some moron agent told them they'd be foolish to take D or N for example.

 

[Nelson C. Janney]

Again, I agree with Midwest. Excess charges hardley ever come up, plus there is a limit of 40% cap on what the Dr can charge in excess.

 

[GreenSky]

Again, I agree with Midwest. Excess charges hardley ever come up, plus there is a limit of 40% cap on what the Dr can charge in excess.

40%? Please provide proof that the physician can charge more than 15% of 95% of the allowable.

Rick

 

[sman]

Again, I agree with Midwest. Excess charges hardley ever come up, plus there is a limit of 40% cap on what the Dr can charge in excess.

Please tell you aren't saying this to your clients?

 

[GreenSky]

Please tell you aren't saying this to your clients?

Are you in any way suggesting that the 40% a doc can charge in excess of Medicare allowable is somehow bullsh*t?

It was posted as fact by an apparently licensed insurance agent.

Rick

 

[SportsNut]

Again, I agree with Midwest. Excess charges hardley ever come up, plus there is a limit of 40% cap on what the Dr can charge in excess.

Me thinks that you've got your wires crossed on some language in the PPACA, aka Obamacrap 2014, aka <65 covg. Nothing to do with M'care and excess chgs.

 

[sman]

Are you in any way suggesting that the 40% a doc can charge in excess of Medicare allowable is somehow bullsh*t?

It was posted as fact by an apparently licensed insurance agent.

Rick

Something like that.