Excess charges in health care refer to the additional costs a beneficiary may incur when a doctor or health care provider does not accept Medicare assignment. This means that the provider charges more than the amount Medicare has approved for a particular service. The excess charge is the difference between the provider's actual charge and the Medicare-approved payment amount.
Excess charges are primarily relevant in the context of Medicare and health care law. They are important for beneficiaries of Original Medicare, as they can affect out-of-pocket expenses. Understanding excess charges is crucial for users managing their health care costs and navigating their rights under Medicare. Users can utilize legal templates from US Legal Forms to create documents related to health care services and billing disputes.
Here are a couple of examples of abatement:
Example 1: A doctor charges $150 for a service, but Medicare has approved only $100 for that service. If the doctor does not accept Medicare assignment, the beneficiary must pay the $50 excess charge.
Example 2: A specialist charges $200 for a consultation, while Medicare's approved amount is $120. The beneficiary will owe $80 as an excess charge if the specialist does not accept Medicare assignment.
Examples of state differences (not exhaustive):
| State | Excess Charge Regulations |
|---|---|
| California | Providers can charge excess fees but must inform patients beforehand. |
| Florida | Excess charges are regulated, and providers must adhere to specific limits. |
| New York | Patients must be notified of potential excess charges before receiving services. |
This is not a complete list. State laws vary, and users should consult local rules for specific guidance.
| Term | Description |
|---|---|
| Medicare Assignment | Agreement by a provider to accept the Medicare-approved amount as full payment. |
| Balance Billing | Charging a patient the difference between what Medicare pays and the provider's actual charge. |
If you encounter excess charges, review your Medicare statement and the provider's billing. If you believe the charges are incorrect, contact the provider for clarification. You can also consider using US Legal Forms to find templates for disputing charges or managing your health care agreements. If the situation is complex, seeking professional legal assistance may be beneficial.
Browse our library of 85,000+ state-specific legal templates.
Contact your provider for clarification and review your Medicare statement for accuracy.