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chisue

Medicare: MD 'opted out'

chisue
15 years ago

My hip surgeon 'opted out' of Medicare. How does this differ from an MD who 'doesn't accept Medicare assignment'?

I have filed with Medicare myself, attempting to get some portion of the surgeon's charge reimbursed. My first claim was rejected because I 'failed to list where the operation was performed'. (Although there was no place on the form that asked that question.) I re-submitted a month ago, attaching the statement of bills and payments and codes for all related procedures as well as his. Nothing back yet.

Medicare paid on all the peripherals to this surgery -- hospital charges, anesthesiologist, orthopedic assistants, pre-op exam and tests, post-op home visits by RNs and PTs.

I would hope to get reimbursed something of the cash I paid the surgeon. I went with him because he is the top MD in the Chicago area for hip replacement and he did my other hip. He is credentialed, qualified, etc. and Medicare would have paid *something* to any other surgeon.

When I see an ENT who 'doesn't accept Medicare assignment', I pay the fee; his office submits to Medicare; I receive a partial refund of what I paid. I don't see how 'opting out' should mean a different result for the patient.

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