Medicare Balance Billing

Transcript: In this video we’re going to discuss the subject of Medicare and what’s called balance billing.

Many times our clients who have been involved in accidents receive Medicare benefits.

When they do receive Medicare benefits, the bills that their doctors have incurred are submitted to Medicare and Medicare pays. They only pay a portion. A doctor might charge $10,000 for a particular service. First Medicare reviews whether that service is allowed, and then maybe if it allows $2,000 for a charge it pays a portion. Under those circumstances, there are occasions where you cannot be billed as a patient by your doctor for unpaid balances that Medicare has not paid–it’s called balance billing. Now there are certain types of Medicare, it’s too complicated in a video to deal with directly, but I can tell you in general there’s a Medicare Part A and a Medicare Part B. What we’re looking at for the balance billing prohibition is mainly the Medicare Part B charges. These can be x-rays, prosthetic devices, can be lots of different therapies and treatments that your doctor has prescribed and provided. And depending on the mechanism by which Medicare has paid those charges your provider cannot bill you for the balance. That’s very important. Let’s say you have therapy that the full charges are $15,000 and Medicare has paid $2,500 and you start getting bills from your therapists saying, I want the difference between $15,000 and $2,500. In many circumstances they are not entitled to that difference and they are not entitled to bill you. So you would be wise to consult an attorney to find out specifically if the type of charge you are being balance billed for is one that is prohibited or one that is permitted. There’s another part of Medicare that we’ll talk about in another video and that’s called subrogation rights or lien rights.