No out of plan doctors if you have Medicare?

[Why Syzygy]

I called an after hours clinic today. My shoulder has been in spasms all night. The personnel told me they cannot accept cash from a Medicare enrollee. Her rationale? If you are on "government subsidy" {sic}, "they figure you can't afford to pay, so it would be fraud".

How can this be true when the Medicare site tells you if the doctor does NOT take assignment, your costs could be higher? What if someone else wants to pay for my medical care in cash? No can do. Fraud. This is BS.

Another doctor's office told me earlier this year that I had to pay cash, but they would show me how to fill out the paperwork to be reimbursed. By Medicare.

Yet another doctor's BILLING office told me that I would be responsible for 20% of lab tests. This is FALSE. If the tests are "medically necessary", and why have them if they aren't, they are paid at 100%. I verified this with the website and by calling.

Can anyone verify or refute that Medicare patients are not allowed to pay with cash?

[sandnsea]

1. Medicare isn't means tested

It's senior insurance for all and has nothing to do with ability to pay. It's possible you are in some sort of low-income HMO type program in Texas which might make the rules different, I don't know. But for straight Medicare it doesn't make any sense. Everybody who is either disabled or retired is on Medicare, no matter how much money they make. I don't understand the problem you're having.

[Why Syzygy]

2. That makes two of us

and very good point. Retirees.

There is no different Medicare program in Texas. It is a federal program.
I'm going to have to follow up on this.

[sandnsea]

3. Some states have waiver programs

That's what I meant. I don't know if Texas has some federal waiver where they're offering some sort of HMO type program to people who would normally qualify for Medicaid but are in some different kind of Medicare program. Part of the new Medicare bill was to put disabled people, particularly, completely into Medicare instead of split between Medicaid and Medicare. Since I don't know your particular circumstances, or every aspect of the new law or every Texas program, I can't really say what that person was referring to. Maybe part of your particular health care program is means tested, whether you completely realized it or not. Generally though, it sure doesn't make any sense to me that you can't pay cash because you have Medicare. I hope you got to see a doctor somewhere along the line.

[Why Syzygy]

4. Did not know that.

I did not realize states could do waivers. If that is the case, Texas no doubt was first in line.
I know there are state programs to pay Medicare premiums and a hospital here has some kind of finacial aid assistance to pay the deductible. So it very well could be. Thanks for the suggestion.

[sandnsea]

5. Well, they're to provide MORE health care

not less, so it's usually progressive states that have waiver programs. But I would suppose if Texas could figure out a way to pretend they were providing more when they were really doing less, they may well have applied for one themselves.

[Why Syzygy]

6. Ack!

Texas uses a Medicare Provider Contractor .. or something ..
Their site says:

Physicians or other practitioners who "opted out" of Medicare for two years for all covered items and services he or she furnishes to Medicare beneficiaries. In a private contract, the Medicare beneficiary agrees to give up Medicare payment for services furnished by the physician or practitioner and to pay the physician or practitioner without regard to any limits that would otherwise apply to what the physician or practitioner could charge.
..

I'm calling them Monday to get to the bottom of this. I hate being ignorant.
Thanks for your patience.

[sandnsea]

7. I remember something about this

A whole bunch of people were losing health care in Texas because the private contractor hadn't sent the proper notifications and letters out, something like that. I bet if you post in GD a bunch of people (younger, with hormones) would remember and be able to give you more info.

We've staved off most privatization in Oregon, but they did manage to privatize workman's comp. Nothing is more shocking than to have to go through one of these privatization schemes yourself and discover how badly they've got the thing rigged. My son like to never got his case settled and by the time he did, he was so desperate just to get some bills paid that he didn't get anything to actually fix his back. People just don't understand until they go through it themselves anymore.

[FILAM23]

8. Medicare pts can pay in cash,

so the fraud part is wrong. On the otherhand clinics and Drs
have the right to refuse Medicare pts even if the pt agrees
to pay cash.

[Why Syzygy]

9. I haven't called anyone

this week. Had enough natural disasters so far. :D