Medicare Non Contracted: Fill & Download for Free

There are several things that people don’t understand about the US medical-care system:The government sets maximum and minimum prices for all healthcare services via its Medicare fee schedule. It’s illegal for a private provider to charge more than the Maximum Allowable Charge for any service, which is calculated based on that fee schedule.The MAC is usually very high, and many providers set their “default” fee to the MAC and adjust the fee downwards based on the amount allowed by payors.It’s also illegal for a provider to discount fees by more than 15% for self-payment or payment at the time of service for any outpatient service.It is, however, legal for an insurance company to receive a discount of any amount, even 100%, if it’s written into their contract with the provider.Many providers treat Medicare patients at a loss. In my home state of Florida, it’s increasingly difficult to find a physician who will accept a new patient who’s covered under Medicare. Non-Medicare patients effectively “subsidize” the practice’s Medicare patients and if Medicare patients exceed a certain percentage of the practice, the practice loses money.Hospital-based billing skirts this liability because hospitals are eligible for grant transfers to cover the costs of “uncompensated care.” But the regulations state that the provider must make an effort to collect uncompensated fees. This is why so many patients wind up being hounded by collections agencies and having medical bankruptcies.It’s illegal for a provider to refrain from billing Medicare for services unless the patient explicitly directs the provider in writing at each visit not to submit the bill to Medicare. If the patient is covered under Medicare, the provider must bill Medicare. If the patient lies and says they’re not covered, the provider is still liable to verify non-coverage.It’s illegal for a clinic to be staffed by part-time physicians. The average physician must spend at least 75% of his or her practice time in the practice for it to be legal. This impacts small rural and inner-city charitable clinics the most.Why do I focus on Medicare?Because the mantra of pro-government healthcare advocates seems to be “Medicare for All.”But there are plenty of other laws that make the US healthcare system a snarled mess of perverse incentives.The McCarran-Ferguson Act (1945)The Medicare Act (1963)The HMO Act (1973)The Stark Law (1990)HIPAA (1996)The HITECH Act (2009)PPACA “Obamacare” (2010)State-level Certificate of Need (CON) laws.If the volumes and volumes of rules and regulations pertaining to medical care are not completely wiped out, leaving a clean slate and starting over, Medicare for All would be a train wreck, driving providers out of practice by the thousands and resulting in maldistribution of doctors, equipment, supplies, and facilities that would make the USA’s recent decrease in life expectancy look like a minor blip.Imposing a new program on top of this existing mess would merely make an already broken system, more broken.The root problem with US medical care is that providing reasonably-priced private care to cash-paying patients is all but illegal.

Why is there so much debate among Democrats about retaining private health care? If there is a public option, why would someone even want their private policy?Would you WANT the following coverage?The public option remains undefined, but appears to be a program you would pay for, a Medicare early.Today - Medicare Parts A and B cost 15,000.00 per year out of the trust fund and general fund, and then require at least 135.50 per month from the insured as added Part B premium.Since you are opting into Medicare early, you would continue to need to make contributions to your retirement age Medicare, so your Medicare tax continuesandyou would need to pay for your current early Medicare use - so you would need to pay in some part of that 15,000.00 per year, as well as the Part B premium of at least 135.50For that 15,000.00 in collective taxed revenue and 135.50 per month you get1364 per hospital stay deductible341 per day days 61 to 90682 per day for days 91 and beyond, until you run out of Lifetime daysfull charge any day past lifetime daysunlimited copay of at least 20% on all medical and drugs in hospital, which could be as high as 35% for non-contracted providersunlimited copay of at least 20% on all medical and drugs in the Dr’s office, which could be as high as 35% for non-contracted providersno dental coverageno vision coverageno hearing coverageno prescription medication coveragethose numbers are direct from Medicarefrom Medicare costs at a glance

They are no “forced” to use that pharmacy. It just happens that that is the one that contracts with their secondary/or part D insurance. They are free to go to anypharmacy they want if they are willing to pay non-contracted prices.