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Can a doctor bill a medicare medical patient if they do not participate with MediCal Medicaid?
Wiki User
∙ 14y ago
There are three categories of medical providers.
Participating providers bill Medicare and accept what Medicare pays.
Non Participating providers decide on a case by case basis. If they do not participate for your service, they send in a claim and the check comes to you. It is the Medicare allowed amount minus your deductible or co-insurance. Medicare allows the provider to bill you 115% of the allowed amount. The Medicare Summary Notice with the check details all of this.
Private contracting providers file a form with Medicare saying that they will not accept any payment from Medicare for any service or any patient. Once they do so, they can not rejoin for two years. However, they must have the patient sign a form that the patient agrees to receive the service an pay for it without any benefit from Medicare.
I will post two links that you might find helpful.
Here is hoping that you do not have to call Medicare. The people are very friendly but their hands are tied.
To answer the question, no. If the doctor is not a medicare provider then medicare will not reimburse the patient or the doctor.
Wiki User
∙ 13y ago
Wiki User
∙ 14y agoI think you mean, can a doctor bill a patient if the doctor doesn't participate in Medical and the answer is yes, as long as the doctor didn't accept the patient as a Medical patient...
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