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Pennsylvania law makes health care more affordable for its older residents.
Called the Medicare Fee Control Act, this law is for seniors who sometimes find it difficult to pay for the health care they need.

More information on the law can be obtained from your local Area Agency on Aging or from the
PENNSYLVANIA DEPARTMENT OF AGING
555 Walnut St., Fifth Floor
Harrisburg, PA 17101-1919
(717) 783-1550

 


Compliments of
State Representative
Anita Astorino Kulik
45th Legislative District

DISTRICT OFFICE:
Coraopolis Office:
1350 5th Ave.
Coraopolis, PA 15108
(412) 264-4260
Fax: (412) 269-2767
http://www.pahouse.com/Kulik

 

 

QUESTIONS & ANSWERS ABOUT MEDICARE FEES

Can you explain how this law affects Medicare charges?
The law protects older people from paying more for doctor visits covered by Medicare. Known as the Health Care Practitioner's Medicare Fee Control Act, the law protects people on Medicare from being overcharged by doctors and other health-care practitioners by making it illegal to charge a higher fee than that approved by Medicare.

What is an overcharge?
An overcharge is the amount of money billed by a health-care practitioner to a patient that is in excess of the Medicare reasonable charge. Many people have never been overcharged by a doctor. For others, the overcharges can total several thousand dollars a year.

How does the Medicare Fee Control Act affect me?
If you are a Medicare recipient, doctors and other health-care practitioners must accept the Medicare reasonable payment for the Medicare covered services they offer. In other words, they may not bill you for more than the reasonable charge set by the U.S. secretary of Health and Human Services.

Is there an example?
A practitioner's fee for a procedure is $130 and the Medicare reasonable charge for the procedure is $100. Medicare will pay $80 and you (or your insurer) must pay the remaining $20. You may not be charged the $30 amount that exceeds the reasonable charge.

Does the Law change what Medicare will cover?
No, the law does not change the list of services Medicare covers. Services such as routine examinations and tests and cosmetic surgery still will not be covered by Medicare.

Will I still be responsible for the 20 percent copayment that Medicare requires?
Yes. Many people carry medigap policies, which cover the 20 percent copayment. Either you or your insurance company still will need to pay the 20 percent copayment. Also, you still are responsible for the annual Medicare deductible.

Are all doctors covered by this Law?
The law applies to all health-care practitioners. This law includes medical doctors, osteopathic doctors, dentists, optometrists, chiropractors, pharmacists, physical therapists and others.

Does this include non-participating physicians?
Yes. Non-participating physicians and providers cannot charge or collect more than the reasonable charge from the beneficiary.

What should I do it I am overcharged in spite of the law?
The Pennsylvania Department of State has the responsibility to enforce the law and resolve claims of overcharges. If you believe that you are being overcharged and want to report your doctor, you should contact the Pennsylvania Department of State Professional Compliance Office toll free at (800) 822-2113. To make a financial claim you must talk to Medicare directly.

What punishment does the Law provide for violators?
The law includes reprimands and substantial fines for practitioners found in violation of the law. These fines will be imposed by the state's appropriate professional licensing board.

 

 
 
 
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