Well one answer for the physician is to not participate..and then they can balance-bill a percentage..but that's not a win for the patients on that side of the coin...so what's the answer....pay the doctors and stop the 10% looming pay cut that is on the books for January...that's a good start...in some areas Medicare is the top payer as contracts with private industry give the physicians only 70% or so of the Medicare published charges, so by accepting a private subsidized plan, they actually end up with less than straight Medicare, but seniors need the plan for medications benefits as straight Medicare might not offer adequate prescription coverage....Catch 22?  BD

Frustrated by Medicare pay cuts, representatives to the AMA House of Delegates directed the American Medical Association to call for national legislation to allow physicians to bill patients for costs Medicare doesn't cover. At its Interim Meeting last month, the house adopted policy directing the AMA to devote its political and financial resources to initiate a measure at the appropriate time that would allow Medicare balance billing. The policy calls for introducing legislation that would end budget-neutral restrictions inherent in a Medicare physician payment structure that interferes with patient access.

With no permanent fix for Medicare cuts in sight, doctors said it makes sense to pursue a law that lets them bill Medicare patients the difference between reimbursement rates and what it costs to treat patients.  "What you see is a symptom of how difficult it is to maintain practices. It's physicians frustrated with reduced income," said AMA Trustee Rebecca J. Patchin, MD.

Nonparticipating doctors who take Medicare case by case may balance-bill patients, but the extra charge is limited to a set percentage of the initial payment.

AMNews: Dec. 3, 2007. AMA meeting: AMA to renew fight for Medicare balance billing ... American Medical News


  1. The vast majority of smaller practices are looking at this option. Patients are going to pay the 10% that congress plans to cut.


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