[foreverromantic]

Does a patient owe a sizeable bill for a surgery if their HMO Medicare Ins. Co. has paid part of the bill, but denied the remainder.
The Ins.Co. has called the Dr.'s billing Dept. many times on this to advise patient does not owe it, now Dr.'s billing Dept. is threatening to send it to collections.
Any advice ?
Thanks

[Alty]

If insurance only paid part of the bill then the rest of the bill is still outstanding, and must be paid. So yes, the patient would owe the outstanding amount that insurance didn't cover.

[ma0641]

You should have rec'd a payment notice from your Medicare company, an EOB, I always do. On it should show "patients balance" of something similar. If balance is 0 then I would not pay. Let the insurance company address the issue. Medicare is done on an agreed pay basis. I have been on it for 10 yrs. without any payment except for co pay or deductible. You may be seeing a co pay amount, you didn't indicate what the problem was.

[Fr_Chuck]

Since this is medicare, not standard insurance, the doctors office if it has agreed to accept medicare must accept the billing prices. There will of course always be an unpaid amount, medicare does not pay 100 percent.

But medicare will provide you will as noted, a EOB, which will show the billed amount, any required medicare discounts, and any co pays that is needed.

You need to report the doctors office if they are not following the required billing

Personally if I had 100 dollars for anytime, someone has threatened to send something to collections on me, I would be a millionaire. If it goes to collection, just send them a copy of the EOB proving you do not owe it.

[ScottGem]

Was the doctor in plan or not? Was the treatment pre approved by the insurer? As noted, with both Medicare and HMO type plans, doctors within the plan agree to accept whatever the insurance carrier pays. However, doctors outside the plan, may not.