By Betty Berry, Tuesday, March 22, 2011
Q: On occasion my doctor’s office asks me to sign some sort of release saying if Medicare doesn’t pay them, I’ll be responsible. Can you explain the reason for such a step?
A: Medicare beneficiaries are often asked by their doctor’s office to sign a form agreeing to pay for specific medical care if it is believed by the provider that Medicare does not cover the particular treatment being provided.
Medicare pays only for services and treatments that are “medically necessary,” and regulations state that if the beneficiary knows or could reasonably be expected to know that Medicare would not cover the service or treatment prescribed, liability for the charge rests with the beneficiary.
Therefore, the provider of services must notify the beneficiary in writing before treatment is given stating Medicare likely will not pay for the services. In that notice, the provider must state the reason why the charge may not be covered. In addition, the advance notice must give the patient an idea of why the provider believes Medicare may deny payment.
This procedure allows the patient to make an informed decision on whether to go ahead with the service and possibly be required to pay out-of-pocket. The requirement for advance notice is not satisfied by a signed statement that merely states if Medicare denies payment, then the patient agrees to pay.
It also is unacceptable for a healthcare provider to issue a general notice stating Medicare denial of payment is possible or that the provider is never sure if Medicare will cover the prescribed service.
Providers should not give such notice unless they have some genuine doubt about the likelihood of coverage. Giving such notice to all Medicare beneficiaries is not an acceptable practice. If you are given such a notice and don’t understand the reasons given, ask for a detailed explanation.
Ultimately it is Medicare that determines if the prescribed treatment or services are covered. Medicare also makes the decision about whether the proper issuance of an “advance notice” of possible non-coverage was provided.
If the patient believes he or she was given an improper notice or chooses to appeal an advance notice, they may do so by submitting a request in writing to Medicare.
Q: I have heard the Thousand Oaks Council on Aging has been providing some very interesting topics at their monthly meetings. Do you have any information about what is on the agenda for April?
A: I, too, have heard some great comments about those presentations.
Yes, I can provide information about the next meeting, which will take place at 1 p.m. April 6 in the boardroom at the Thousand Oaks Civic Arts Plaza, 2100 E. Thousand Oaks Blvd.
These meetings begin promptly at 1 p.m. as they are televised and have a live audience. There is a light lunch reception from noon to 12:45 p.m., when you can meet the speaker and talk with council members. Reservations for the reception are required and can be made by calling 449-2743.
April’s program will focus on “Transportation for Seniors.” This is a topic near and dear to every senior and one they should plan to attend.
The program will be facilitated by Mike Houser, a city of Thousand Oaks transportation analyst.
The issues to be addressed are enhanced hours, new reservation policies and expanded service areas for Dial-A-Ride; planned bus service changes; and funding.
Transportation is an important part of life, so why not plan to attend and get the answers you need.
— Betty Berry is a senior advocate for Senior Concerns. The advocates are at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, CA 91362; phone 495-6250 or email firstname.lastname@example.org (please include your telephone number). You are invited to submit questions on senior issues.