17 Nov 2007
For Agent's Information Only
Unassigned Claims, Excess Charges etc.
I had a good question yesterday about excess charges on Medicare Supplement claims. I'm sure there are more of you out there that would benefit from the Q&A so here it is:
It's the "excess charges" I don't understand. Both
plans pay the difference between the medicare approved
amounts and the 80% that A actually pays. What other
excess amounts are there?
"Ok--No problem. I think the confusion comes in on what are called "un-assigned" claims. These are claims where the MD's do not accept Medicare's "assignment" or in other words the do not accept what Medicare "approves" as payment in full. The difference between what the MD charges and what Medicare approves is called an "excess charge."
An excess charge is the amount over what Medicare Approves.
Let's say the MD bills Medicare for $115 and Medicare only approves $100. Assuming the Part-B Deductible was satisfied, Medicare Would pay $80.00 (80%). That leaves $35.00 left (20% of the %100 = $20 and the $15 excess) - if the MD accepts assignment (in other words accepts Medicare's approved amount) the MD waives the $15 excess and the client would only owe $20. Any of the plans would pay the $20 co-insurance amount. If, on the other hand, the MD does NOT accept assignment that means he wants the full $35 balance. Only plans such as Plan F which cover excess charges will pay the extra $15 or $20 + $15 = $35 total.
* Note: NY Limiting charge law = MD can only charge 5% more then what Medicare approves - outside NY can by 15%.
Hope this helps.
Here's a link to the outline of coverage which shows what each of the standardized plans covers: http://files.lrcassoc.com/FUA/Outline/FirstUnitedAmericanOutlineOfCoverage.pdf
If you'd like the power point presentation which explains how the Medicare Supplements work you can order that and your initial Medicare Supplement Kit here: http://www.lrc-ga.com/medsupprequest.html
Have a great weekend.