What You Can Do If Your Doctor Has Opted Out of the Medicare System

Many Medicare recipients are being hit with a startling discovery when visiting their doctor for their annual or routine examination. What is that startling discovery? They are discovering their primary care physician as well as a number of specialty practitioners they have been seeing for years have already done so, or intend to soon, opt out of the Medicare system or not accept any new patients under Medicare. This situation is occurring in every one of the 50 United States at an alarming rate.

Many of the doctors cite two main reasons for making their decision to pursue this action. They choose to opt out of Medicare because the paperwork they must process for payment is voluminous. The Medicare system has been the victim of ravenous fraud and abuse over the years. To cut down on this abuse they have instituted a number of reporting changes which have resulted in the doctor's office having to submit a number of forms and reports to substantiate their claim for payment.

The second reason doctors give for opting out of the Medicare system is Medicare's reimbursement rates are too low. The amount Medicare pays for a procedure is always lower than the average doctor's office standard fee. Medicare's reimbursement fees have not kept up with inflation and the cost of doing business, thus making doing business with them a liability. It is just common sense to realize operating at a loss will cause your business to go bankrupt. While the doctors are humanitarians and wish to use their talents to heal and help people, they are also business people and have a responsibility to their staff, suppliers, and their family. If they do not get paid, they are unable to honor their responsibility to those who look to them for support.

Once the doctor has opted out of the Medicare system, they are free to charge whatever they want for the services they provide. However, neither they nor you, the patient, can bill Medicare for reimbursement. The Medigap insurance coverage a number of Medicare recipients carry to cover the balance between the actual doctor's bill and the Medicare contributions, are not eligible to apply either. You, the patient, are responsible for paying the entire bill.

There are approximately 40 million Americans 65 years old or older who have Medicare insurance. It is estimated that up to 25% of them may see their doctor or one of their specialty practitioners opt out of the Medicare system within the coming year. If you are approaching Medicare eligibility your should talk to your doctor as soon as possible to find out if they intend to or already have opted out of the Medicare system. If so, it would be advisable for you to start looking immediately for a replacement doctor who accepts Medicare, while you are still healthy. For those of you whose doctor have already left the system, you can see if it is possible to work out payment arrangements with them or find another doctor. Medicare maintains a directory of participating doctors at www.medicare.gov.

Resource: Personal Experience