The ban on balanced billing law protects you from being overcharged
As long as you are covered by Medicare, your Massachusetts physician can charge you no more for a service than the rate that Medicare allows for that service. The Medicare rate is the highest you can been charged for the service whether or not your Massachusetts physician accepts “assignment”, that is direct payment from Medicare. This law is called the Ban on Balanced Billing
Does the ban on balanced billing apply to all medicare providers?
No. This limit on billing Medicare patients applies only to Massachusetts physicians. Other Medicare Part B providers are limited to charging no more than Medicare’s approved rate of charge if they accept assignment or if there are Medicare limiting charges.
What should i do if i disagree with a claim decision?
You should call both your medical provider and the insurance company referred to in the Medicare Summary Notice with questions about your medicare claim if you are unhappy with a coverage determination. If you do not receive a satisfactory response, you may appeal your claim decision. Appeals may be filed whether or not your claim was assigned. The claim will include instructions for appealing a Medicare decision.
Should i have legal representation when appealing a claim?
It is helpful to have legal representation when appealing denials of Medicare coverage because the laws regarding Medicare are very specific and sometimes confusing. A legal representative will review the services that you received to be sure that you qualify for Medicare coverage.
Is it worth my time and effort to appeal an unfavorable medicare claim?
You should appeal if you have received services that you believe Medicare should have covered. You have nothing to lose. and appealing will not jeopardize your Medicare benefits.
If you have questions about your Medicare claims or need legal advice, contact your local MAP office or call the Medicare Advocacy Project at Greater Boston Legal Services at (617) 371-1234 or 1-800-323-3205.