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.” 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 must notify the beneficiary in writing before treatment is given stating that 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 might deny payment.
This procedure allows the patient to make an informed decision as to whether to proceed with the service. 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 is also unacceptable for a health care provider to issue a general notice stating that 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 receive a notice and don’t understand the reasons given ask for a detailed explanation.
Ultimately, Medicare determines if the prescribed treatment or services are covered. Medicare also decides whether the proper issuance of an “advance notice” of possible non-coverage was provided. I suggest that you ask for a copy of any notice you sign.
If the patient believes he or she received an improper notice or chooses to appeal an advance notice they may submit a request in writing to Medicare.
Q: I am concerned about the number of appeals for money I receive in the mail. I’ve heard so much about scams that I hesitate to respond to any. How can I tell if they are legitimate?
A: It does seem that our mailboxes contain more requests for our hard-earned dollars, but that doesn’t mean all requests are scams. Many legitimate organizations find mail solicitation an efficient method of funding.
There are, however, a number of steps to take before opening your heart and checkbook. Read the appeal thoroughly to make sure it clearly identifies the charity and the programs it serves. Is it really from the organization you think it is from? Many solicitors deliberately use a name similar to a well-known agency hoping the receiver will think he or she recognizes the name and automatically respond.
Look at how the charity uses its funds. The majority of money collected should go directly to pay for the programs offered. Watch out for statements such as “all proceeds will go to the charity.” This can mean that money left after fundraising expenses will go to the charity. Fundraising expenses can be high depending on the type of event planned.
Don’t be overly influenced by stories or pictures in the literature or by a celebrity making a sales pitch. Concentrate on the substance of the message. Do their goals and methods coincide with your beliefs?
It is wonderful to support worthwhile charities and it is sensible to do so with care. Always remember to contribute with a check, never cash, and to make the check payable to the charity and not to the person making the request.
July 22: Transit workshop, 12:30 p.m. at Goebel Adult Community Center, 1385 E. Janss Road in Thousand Oaks.
Aug. 20: “Will You Pass Your Next Driving Test?” seminar, 1:30-3 p.m. at Moorpark Active Adult Center, 799 Moorpark Ave. in Moorpark. For reservations call 517-6261.
AN ADDED THOUGHT:
Goebel Adult Community Center is seeking photos for a Veterans Day event. The center is creating a slide show for their upcoming Veteran’s Day Breakfast and USO Show in November. They would love to share photos of veterans in uniform. Please bring your photo to Goebel’s front desk. They will make a copy to be included in the slide show. For more information call 381-2744.