Keeping doctor after he stops taking Medicare

I have been under the care of an OB/GYN for a Prolapsed Uterus. When I called the office for an appointment, I was told he will no longer handle my case because he does not accept Medicare. I was referred to the other doctors in the practice there.  I have confidence in this doctor and I am not interested in having these other doctors care for me.  What should I do?

Unpleasantly Surprised

Dear Unpleasantly Surprised,

Even a doctor who does not “accept” Medicare can see Medicare patients and help you get the fees at least partly paid by your plan.  You might have to pay his fees from your own pocket, and then get paid back by Medicare. His office should submit the claim for you and they can’t charge you for doing this. Or you can submit the claim yourself. The claim form is online: Form CMS-1490S.

Since he is not “participating” with Medicare (also called “accepting assignment”), he is allowed to charge you up to 15% more than what Medicare pays to non-participating providers. This 15% limit does not apply to all services, however. Call the plan to find out the details.

So, he got rid of Medicare as a payer but he doesn’t have to get rid of you as a patient. Brace yourself for educating the office staff.  They apparently did not offer you this option when you called for an appointment, so they may not be enthusiastic about it.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.