(MEDICARE) MDS WHO DONíT ACCEPT IT

CMS is in the process of mailing Medicare and You 2006 to those eligible for Medicare. The following is an excerpt from that publication that everyone on Medicare should understand:

Section 5: Medicare Program Basics - Using Doctors Who Don't Accept Medicare

Some doctors do not accept Medicare payments. If you want to get care from a doctor who doesn't accept Medicare payment, you may be asked to sign a private contract.

A private contract is a written agreement between you and a doctor who has decided not to participate in the Medicare program. The private contract only applies to the services you get from the doctor (such as a physician, dentist, podiatrist, or optometrist) who asked you to sign it.

You can't be asked to sign a private contract in an emergency situation or when you get urgently needed care.

If you sign a private contract with your doctor you will have to pay whatever this doctor or provider charges you for the services you get. Medicare's limiting charge won't apply. No claim should be submitted to Medicare and Medicare won't pay if one is submitted.

Your Medigap policy, if you have one, won't pay anything for this service.

Medicare health plans won't pay any amount for the services you get from this doctor. Your doctor must tell you whether Medicare would pay for the service if you get it from another doctor who participates in Medicare. Your doctor must tell you if he or she has opted out of or has been excluded from the Medicare program.

You may want to talk with someone in your State Health Insurance Assistance Program before signing a private contract (see the inside back cover of your Medicare and You booklet for their telephone number).