Bill – California: Last July, I paid in advance and in full $1,131 for chiropractic services to be rendered over the next 12 weeks — a dumb move on my part, but I didn’t know any better at the time. Is the doctor, a California-licensed chiropractor who told me he accepts Medicare, even allowed to collect the full payment for 29 session in advance of rendering services?
I finished these treatments and am no longer under this doctor’s care, but I still haven’t been repaid by Medicare for these sessions. I called the agency and was shocked to learn that no claim on my behalf has been received! I then spoke with the doctor. He told me that a claim was attempted three times with various glitches and that he would submit it again in one or two weeks. He also told me in an unprofessional huff that he has a year to file my claim. What’s my recourse? Or have I been scammed?
Phil Moeller: Experts at the Medicare Rights Center say that doctors who accept assignment from Medicare should not be billing patients in advance for the entire sequence of their services. Assignment means the health care provider agrees to accept Medicare-approved charges as payment in full for their services.
Most doctors who accept Medicare also accept assignment, but it’s possible for a doctor to accept Medicare patients without agreeing to assignment. Such “non-participating” doctors can bill you more than the Medicare-approved amount for their services, although Medicare rules do limit such overcharges. These doctors also can bill you the entire charge for their service.
It sounds like your chiropractor is a non-participating provider. You should confirm this, and it’s hardly being pushy to do so. If he does accept assignment, you have the right to squawk to Medicare about being required to pay for all his services up front. Whether you do so or not may depend on whether you want to continue using him. After all, as you note, you’ve already paid him.
He also is correct that he has a year to file your claim and reimburse you. The Medicare Rights Center suggests that you closely track the quarterly Medicare Summary Notices you should be receiving from Medicare to see if the claim has been filed. If you haven’t done so already, you also can set up an online Medicare account and get your Medicare Summary Notices electronically. And if the claim has not been processed, you can either ask your doctor again to file it, or if the year deadline is approaching, you can file the claim yourself using Form CMS-1490S.