My doctor mentioned something about Medicare not covering my procedure. How do I find out for sure before I get stuck with a bill?
Answered by 5 licensed agents
Suppose you're under Medicare Part A and Part B with a Medicare supplemental insurance, and the physician sees a need for a diagnosis due to your health circumstances. In that case, the procedure should be covered, less any amounts for Medicare Part B premium or deductibles, and this is based on the type of supplemental plan you have. If you're on Medicare Part A and B with a Medicare Part C - Advantage plan, then your coverage could only be determined with the prior approval procedure through the insurance carrier of your Advantage plan. Most likely, there will be additional deductibles, co-pays, or out-of-network charges under these plans.
Answered by Larry Dalton on April 3, 2025
Broker Licensed in OK & TX
The only healthcare procedures that are NOT covered are those of an experimental nature. However, once the CDC checks out these types of treatments, as long as it meets the quirky Federal guidelines, it may be declared to be covered. Be advised that there are over 60,000 treatments that are currently covered by Medicare. Your doctor was being honest with you and the odds are that most of the "uncovered" treatments are those recommended by a chiropractor since they can (via trial-and-error) attempt to develop a procedure that she/he successfully worked with "some" of their patients. Your best double-check is always to call 1-800-MEDICARE and the reps should be able to sanction a procedure unless it is brand new and has yet to be tested.
Have a predetermination submitted to see if it is covered.
You can find many answers for Medicare supplement plans in the Medicare guide and website
Medicare advantage plans require you to be contact your insurance company
Answered by Gary Henderson on April 8, 2025
Agent Licensed in TX, AK, AL & 46 other states
To ensure your procedure is covered by Medicare before incurring unexpected costs, you should first ask your doctor or the facility if they accept Medicare and if they will accept assignment. You can also verify coverage on the Medicare.gov website . If coverage is uncertain, inquire about potential out-of-pocket costs and ask if the provider will file a claim with Medicare, even if they anticipate a denial.
Answered by Vachik Chakhbazian on April 11, 2025
Agent Licensed in CA, AL, AR & 22 other states
Call us about your plan and we can tell you or tell you who can. Knowing we are here for you is a valuable resource.
Tags:
Advice for Seniors
Coverage
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