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> Yeah, that's nonsense. Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients f

> Yeah, that's nonsense. Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover. You actually can end up in a situation where you can't pay out of pocket for additional services because the only providers available (logistically or practically) cannot accept those payments.

CalChris 4y ago
> accepts Medicare and Medicare won't pay for a procedure Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. > Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. After that you'd have to show me the rule that says a participating dermatologist can't charge what they want for cosmetic surgery. Medicare has rules for what they cover (What's Covered) and what they'll pay (Medicare Assignment). Medicare Advantage has some rules but it also manages your costs and their profit.
- chimeracoder 4y ago
  > Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. That's not what I'm talking about at all. I don't know where you got "cosmetic surgery" out of that. A common pattern is that Medicare will only cover a certain service X times per week/month/year. Because their limits are inherently coarse by design, they're not going to be appropriate for all patients. A patient for whom (X+2)/(unit time) or even 2X/(unit time) would be more appropriate can only obtain the additional services from another provider altogether. Which, in plenty of circumstances, may not actually be literally possible. > First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. Incorrect. Non-participating providers can only charge the limiting charge (usually 15% more than the Medicare reimbursement rate, though some states cap it at a lower value).
  - CalChris 4y ago
    So we're talking about two different things (and thus in a sense, both right). By non-participating you're referring to Extra Charges as opposed to what I'm thinking of, a doctor who is not accepting Medicare payment at all and is thus unencumbered by its rules. Yes, the first case is limited by Medicare Assignment. BTW, it's not exactly 15% either. It's a strange calculation. It's pretty rare. Plan G covers it. I think Mayo, Cleveland, ... may charge it. I don't know why a doctor wouldn't charge it but it's uncommon.

CalChris 4y ago

> accepts Medicare and Medicare won't pay for a procedure Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. > Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. After that you'd have to show me the rule that says a participating dermatologist can't charge what they want for cosmetic surgery. Medicare has rules for what they cover (What's Covered) and what they'll pay (Medicare Assignment). Medicare Advantage has some rules but it also manages your costs and their profit.

chimeracoder 4y ago
> Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. That's not what I'm talking about at all. I don't know where you got "cosmetic surgery" out of that. A common pattern is that Medicare will only cover a certain service X times per week/month/year. Because their limits are inherently coarse by design, they're not going to be appropriate for all patients. A patient for whom (X+2)/(unit time) or even 2X/(unit time) would be more appropriate can only obtain the additional services from another provider altogether. Which, in plenty of circumstances, may not actually be literally possible. > First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. Incorrect. Non-participating providers can only charge the limiting charge (usually 15% more than the Medicare reimbursement rate, though some states cap it at a lower value).
- CalChris 4y ago
  So we're talking about two different things (and thus in a sense, both right). By non-participating you're referring to Extra Charges as opposed to what I'm thinking of, a doctor who is not accepting Medicare payment at all and is thus unencumbered by its rules. Yes, the first case is limited by Medicare Assignment. BTW, it's not exactly 15% either. It's a strange calculation. It's pretty rare. Plan G covers it. I think Mayo, Cleveland, ... may charge it. I don't know why a doctor wouldn't charge it but it's uncommon.