Medicare Excess Charges Connecticut
Medicare Excess Charges Connecticut: Medicare excess charges or sometimes called excess billing is applied by doctors that do not accept Medicare assignment. A doctor who chooses not to accept assignment is able to bill a patient 15% over the allowable Medicare charges. However, Those providers are not able to bill over Medicare allowable limit on all charges. Some items that providers cannot use the excess charge on include Durable Medical Equipment. This is true even if they are not accepting assignment. Non par is another way of saying that the doctor does not have to accept the Medicare contracted price for services. You should not confuse Non par with a Medicare opt out. An opt out is when a doctor does not participate with Medicare. Medicare will not provide any coverage for services rendered by an opted out physician or facility.
Be very careful when you ask a provider if they “take” your insurance!
You might think, if the provider says that they “take” your insurance they participate with your insurance carrier. This is not always the case. This only confirms that they will accept payment from your insurance company and they may submit your claim for you. It does always not mean that they have a contract with your carrier.
If you want to be sure, you should always ask healthcare providers if they are contracted as a participating provider with your insurance carrier. Unfortunately, there are some providers out there who will mislead you with their wording in order to get your business. This is more common than you would think. For this reason you must ask the right questions to avoid costly situations. Your carrier cannot protect you from any carrier they do not have a contract with.