The Original Medicare covers the Part A and Part B. There can be cases where the doctors charge an excess amount to the customers over and above the Medicare-Approved rates. These charges are known as Part B excess charges. The doctors can levy a maximum excess of 15% over the Medicare-approved rates. Paying the excess charges can be a costly affair for the customers and they need to be clear on when and how these excess charges are levied. Some of the key details on Part B excess charges are as follows:
What is Part B Excess Charges
The Medicare prescribes the Medicare fee schedule which are the Medicare-approved charges for Medicare-covered services. A doctor who does not accept the assignment can charge an excess over the Medicare-approved charges. As per law, the doctors can charge a maximum of 15% over the Medicare-approved rates. The customers either pay these excess charges themselves or the Medicare Supplement plan pays the same depending upon the plan. Any customer can face three different possibilities while visiting a doctor which are as follows:
The Doctor Accepts Medicare Assignment
If the doctor accepts the Medicare Assignment, then they cannot charge any excess charges over the Medicare-approved rates for medical procedures.
The Doctor Accepts Medicare but not Medicare Assignment
If the doctor accepts Medicare but not the assignment, then they can charge the customers up to 15% excess of the Medicare-approved rates. The excess charge is then paid by the customer or by the Medicare Supplement plan if they have the Plan F or Plan G.
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The Doctor does not Accept Medicare
If the doctor does not accept Medicare also, then the customer has to pay the entire amount themselves. The doctor needs to demonstrate to the Medicare that the charges being levied are fair. The customer then needs to submit the bills to Medicare for any reimbursement.
Ways to Avoid Part B Excess Charges
The customers should be proactive for avoiding Part B excess charges. They should inquire and confirm from their doctors beforehand if they accept Medicare and Medicare Assignment or not. If their doctor accepts the Medicare Assignment then they do not have to pay any Part B excess charges. It is better for the customers to visit doctors accepting Medicare Assignment to save on any excess charges. There are few states which prohibit any excess charges. Thus if the customers are residents of Connecticut, Massachusetts, Minnesota, New York, Ohio, Pennsylvania, Rhode Island, and Vermont, then they do not have to pay any excess charges.