July 2023 – Author Artist

The time of year for us senior citizens to make decisions on what kind of Medicare do we need.

I would say it would be determined by your income.

I would say it would be determined upon your health.

I would say it would be determined upon your doctor.

Now that you have determined this what is next.

But how do you determine if your doctor is on your Medicare plan.

Call Medicare. The customer service representative can tell you if your doctor is on your plan.

Medicare Plans

Regular Medicare

You pay 80% of your bill and you pay the 20%.

You can have a secondary insurance to cover the 20%.

HMO

This is the cheapest way to go but also the most aggravating.

You must pick a (PCP) a Primary Care Physician.

You must go by referral to a specialist or medical test.

You must have an authorization to have surgery or some specific test.

You must stay inside the contracted arena of medical care for your HMO.

PPO

You have more control over your medical care. But it does cost more.

Medicare/Medical or Medicaid

You need to qualify for this insurance.

It is for low income.

Whatever insurance you decide to go with always check with Medicare to make sure you are up-to-date in their computer system. 1-800-633-4227

www.lindameckler-author-author.com

My books Medicare and Other Health Insurances and Appeal and Collections Letters are available on Amazon.com.

Thank you for reading my article. Linda Meckler 2023 copyrighted

Understanding Medical Insurance Contracts

What most people do not understand is the way medical insurance works. In plain English, it works by insurance contracts. The insurance companies are the ones to blame for this big mess in the healthcare system. They make all the money and love to keep their clients confused as to what it is all about. When the knife slices the reality of what it is and what it isn’t paying for it is too late.

A Medical Provider is a doctor, laboratory, hospital, ambulance company, x-ray lab, etc. Each medical provider signs a contract with each individual insurance company they want to be contracted with.

Every contract is different. With a doctor, it would be considerably different than it would be with a hospital.

This contract simply states that the medical provider will accept this insurance or that insurance and receive a percentage of payment.

Now with each insurance company the percentage changes.

Employers: The employers or business owners sign a contract with the insurance companies. This is where it becomes confusing. There are many different plans with the insurance company.

Medicare

Straight Medicare-

You pay 80% of your bill.

You may have a secondary insurance.

HMO – This is where you have a PCP or Primary Care Physician. You need a referral to see a specialist and authorization to have surgery or some sort of test. These medical providers you will be scheduled with are within your medical contract. You pay a copay with each visit.

PPO – This is when you can make your own appointment with a specialist. You pay more for this insurance and you can go out of the contract of medical providers but it will cost more.

Straight Commercial Insurance – This is when you pay your contracted rate and a percentage of what your insurance doesn’t cover.

This is why when patient A goes to Dr. Brown and has a general examination of blood pressure and a blood test. The insurance will pay a certain percentage and the patient will be charged the rest after something has been adjusted off per the contracted rate.

Patient B same thing, the same doctor. But when patient B receives his Explanation of Benefits (EOB) from insurance the rate the patient is expected to pay is different.

This is because of the name of the insurance company and the type of plan that was picked.

FOR MEDICAL PROVIDERS

My book Appeal and Collection Letters is for you.

If you have any questions please contact me on my website www.lindameckler-author-artist.com

Linda Meckler author of over 25 books and worked in Medical Insurance Billing for over 25 years. Her book Medicare and Other Health Insurances. Explains in simple English how Medical Insurance Works, sample Appeal Letters, and much more.

Month: July 2023

Medicare ????????????

Elementor #1790