Will Medicare reimburse me for a covered procedure if I have to use a doctor who does not take Medicare?

Question

Will Medicare reimburse me for a covered procedure if I have to use a doctor who does not take Medicare?

Follow

Share

I have oral cancer and my teeth need to be extracted for the purpose of radiation trestment. This is a covered medicare expense but I cannot find an oral surgeon who accepts medicare. Since I have to pay out of pocket, will medicare reimburse me any of the costs?

Medicaid

This question has been closed for answers. Ask a New Question.

12 Answers

Most
Helpful Newest
First Oldest
First

You will need to keep looking for a doctor who accepts Medicare.

Helpful Answer (1)

Report

You can call Medicare and speak to an agent that will help you find a doctor that does take Medicare. I called about supplemental insurance and a doctor for my brother and they gave us a doctor's name and helped him decide on the supplemental insurance. They were very helpful.

Helpful Answer (0)

Report

how sad that you have to worry about this :( I pray you will find the right doctor.

Helpful Answer (0)

Report

Medicare will NOT reimburse you. Keep looking for a dentist who accepts Medicare and if you have to travel elsewhere do so because having had many dental procedures due to bisphosphonate use (Fosamax) dental issues are really expensive (if you have to pay for them yourself). Best wishes! (Look for a dental university dental clinic for reduced costs).

Helpful Answer (2)

Report

Thank you for your responses everyone! My situation is a real travesty. Full teeth extraction is going to cost $7800. Since medicare does not dental services, finding a dentist who is a medicare provider is utterly impossible yet the guidelines are very specific that my teeth extraction is a covered expense. I found a claim form online for reimbursement. I'm going to submit it with my bill and try to get reimbursed for something. I know I will not get anywhere close to $6800. My situation seems to be the needle in the haystack.

Helpful Answer (0)

Report

I'd suggest contacting the Medicare Rights Center National Hotline to see if they can help you: 800-333-4114. They're a nonprofit and have volunteers and staff who help Medicare beneficiaries understand and access their benefits.
You could also try your state's SHIP (California's is called HICAP: Health Insurance Counseling & Advocacy Program). Here are the #'s for the Sacramento branch: (916) 376-8915 or toll free (800) 434-0222
HICAP should also have trained volunteers who can help counsel you; the benefit is that they're local to you, so they might know of local resources to help you.
According to Medicare, your tooth extraction is indeed a covered expense because Medicare covers "extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw" (According to the Centers for Medicare & Medicaid Services). The problem is finding a Medicare provider who will do it.
I wish you the best in getting this procedure done so you can get on with your treatments and get back to good health!

Helpful Answer (0)

Report

I called the 1800 medicare number and found out they will reimburse me; however, the rep re confirmed that I will not recoup all my money since medicare rates are significantly lower that what the market rates would be. This is just wrong on so many levels. Hoping the reimbursal process goes smoothly.

Helpful Answer (0)

Report

Several years ago when I was taking care of my late mother-in-law's finances, she saw a doctor who did not accept "Medicare assignment". This meant that he did not accept what Medicare allowed as full payment, and he was allowed to bill for the difference. His office still submitted the claims, but I had to submit them to MILs supplemental insurance. Supplemental ins sent their payments to me, and I endorsed them over to the doctor. There was a small balance to pay from MILs funds. If a doctor accepts "Medicare assignment", he/she agrees that the Medicare allowed amount (which includes deductibles and co-pays) is payment in full for the services provided. Haj1229, ask the oral surgeon's billing person is they will submit your claim to Medicare for you. They probably submit claims electronically and it may make the reimbursement process go more smoothly. Also, if you have a supplemental ins plan, the claim may go directly from Medicare to the supplemental company saving you further paperwork and hassle. Best wishes for a smooth recovery.

Helpful Answer (1)

Report

I had almost forgotten what I did regarding my dental expenses which were actually billed with Medicare under the "MEDICAL" benefit. It took one year to get reimbursed, but I got more money than I had paid. But, I have Tricare for Life, and after Medicare denied the claim, then I submitted the reimbursement to Tricare who delayed and delayed, but I got paid back. You need the denial from Medicare first, then submit a bill for reimbursements, but make sure you put down the "medical necessity" for having your teeth extracted. I wish you could come to AZ. My best wishes to you.

Helpful Answer (0)

Report

While I'm a bit late reading your question, the answer is--(and you have some good answers already) if you're covered by Medicare, you're covered, and they pay according to their schedule for the procedure(s). You just must get and submit the form w/ appropriate supporting info. Wrote a post on this subject in Jan. 2015. Am confident you'll get some reimbursement

Helpful Answer (0)

Report

Thank everyone! Again, all your responses are appreciated. Funny thing now is I am getting push back from the oral surgeons office. I explained to them that I need an itemized receipt for the purposes of Medicare reimbursement. They keep telling me they aren't Medicare providers. Duh. All I want is an itemized receipt. I can't tell if they are not very smart or trying to hide something. I'm sure I'm being charged a ridiculous amount of money for this surgery since I am private pay but I don't care at this point. It just has to get done.

Helpful Answer (0)

Report

Something seems wrong here - there should be no problems with an itemized receipt - standard practice really. I had a problem with a medical billing years ago and got a real run around from the hospital rep I talked to. Finally I demanded to talk to a supervisor (if that hadn't worked I would have just gone to the hospital's business office and sat there til I got what I wanted.) They kept telling me that the doctor ordered this test - well I knew that. Finally I explained that I needed to see the itemized billing to be sure that I had got everything I was being asked to pay for. That startled them - they had some idea that I just should trust them and the insurance company would cover everything. I explained about my deductible and that I would be paying for this myself, out of pocket. Finally I got the bill and then sat down with the supervisor to go over item by item to be sure I understood what was on that bill. Well, I discovered that the bill was not correct - in fact twice as much as it should be because I was being charged for an additional procedure that was not done. Well I got an amended bill, paid it, but I still wonder if it was an honest mistake or if they thought they could cheat the insurance company. There is a real problem about medical "shopping" - too many doctors seem to think we are all the Queen of England and never give a thought to anything as vulgar as money.

Helpful Answer (0)

Report

This question has been closed for answers. Ask a New Question.

Will Medicare reimburse me for a covered procedure if I have to use a doctor who does not take Medicare?

12 Answers

Recent Questions

Popular Questions

Related Questions