What is Medicare Assignment?
There are certain doctors out there who do not accept Medicare assignment, and as a result you may be charged more than the Medicare approved amount for the service. These doctors are not allowed to charge you more than 15% over the Medicare approved amount, this is known as "charge limiting"; and only applies to certain services. Some Medicare supplies like Durable Medical Equipment (DME) do not receive charge limiting. When purchasing supplies like DME, Medicare will only pay for them if the supplier is enrolled in Medicare. If they are enrolled in Medicare, then it does not matter who submits the claim to Medicare, either you or the supplier may do so. It is also important to note that some states prohibit doctors from excess billing as described above. New York, Massachusetts, and Connecticut are just a few states that fall under this ruling.
In some circumstances, your doctor will recommend that you receive a service that Medicare does not cover. This situation would leave you footing the bill for a portion of the service's cost, if not the whole cost. It is important to ask your doctor questions about their recommendations and whether or not Medicare will cover them. Lots of people like to use the blanket statement of, "I only want to receive procedures that are approved for coverage by Medicare. I must be told of any service that Medicare will not cover before it is performed." Using this statement before receiving care from a provider can help elimate any excess billing you may have incurred otherwise.
