“Why Are So Many Good Physicians Opting Out of Medicare?”

This creates a large contingent liability to Medicare that good doctors cannot carry on their books and still provide services at break even or below their cost. Medicare administrators are charging thousands of dollars for services provided under rules that are now changed administratively and going back 5 years to charge the doctors retroactively. Doctors may be entitled to sue for this, except the cost of litigation is more that the refund asked. Either way the Doctor loses. So rather than fight a loosing battle, the doctor says no more Medicare for my patients. Fewer doctors providing for many more patients equals rationed medical services. This is especially hard for TOS patients, because only 5 % of the doctors are Neurologists who understand TOS.

• In an article published in The New York Times, journalist Julie Connelly writes that many people are discovering “that the insurance rug has been pulled out from under them.” Many doctors – internists, gastroenterologists, gynecologists, psychiatrists and other specialists – are finding it to their advantage to opt out of Medicare. Why? Because reimbursement rates are too low and the paperwork, too overwhelming. This has caused many doctors to either opt out of Medicare completely, or not accept new patients with Medicare coverage.

In the future you may have to pay for your TOS doctor privately, just like our Canadian friends that must come to the US and pay for TOS help not covered by the Canadian health care system.

• Doctors who are enrolled in Medicare fall into two categories – participating and non-participating. In order to be a participating provider, doctors must agree to accept pre-determined amounts set by Medicare for services rendered, they’re not allowed to charge additional fees. In contrast, non-participating providers receive a lower reimbursement from Medicare, meaning if the doctor sets a higher fee for service than Medicare allows, patients must pay the balance out of their own pockets. Doctors who choose not to participate in the Medicare program can charge whatever they want, but they can’t bill Medicare and either can the patient. In this case, the responsibility for payment lies completely on the shoulders of the patient, as even Medi-gap, a supplemental insurance that covers gaps in coverage left by Medicare, won’t pay any of the bill if Medicare doesn’t.

Phil La Puma, P.E., CHt, CHI, CECP
TOS Society ™

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