Can a Medicare-friendly doctor demand payment in full first?

A fellow caregiver asked...

Can a doctor, who publicly presents that he accepts Medicare insurance at all locations, demand payment in full for services rendered before submitting a Medicare claim?

Expert Answer

Unfortunately, yes. There are two ways a doctor can get paid for treating you as a Medicare patient. If the doctor accepts "assignment," that means he may not charge you any more than the Medicare-approved amount for the services provided. In this case, he may require that you personally pay him your Medicare Part B deductible (if you haven't already paid it for the year) and the 20 percent coinsurance amount that Medicare doesn't pay. He can require that you pay these amounts before he provides the services. He is then required to file a claim with Medicare for the remaining 80 percent payment he's to receive.

If the doctor doesn't accept assignment of the Medicare-approved amount as payment in full, he may require that you pay in advance some or all of what he charges for the services he's providing you. He's then required to file a claim with Medicare on your behalf, and Medicare will reimburse you directly for 80 percent of the amount it approves for the services.

For a full explanation of these rules, take a look at the Medicare web site page How to File a Claim .