July 09 Marci's Medicare Answers

Dear Marci, I get sunburned very easily and have been getting screened for skin cancer since I was young. I will be eligible for Medicare this summer, and I would like to know if Medicare will cover these screenings. Olivia Dear Olivia, No, Medicare will not cover screenings for skin cancer. If, however, you see a suspicious-looking mole, you should make an appointment with your doctor as soon as possible. Medicare will cover a diagnostic doctor's visit and any diagnostic tests your doctor considers medically necessary. You may be able to find a doctor who will give you a free skin cancer screening by visiting the American Academy of Dermatology's website (www.aad.org/public/exams/screenings/index.html). Marci Dear Marci, When I see my doctor, must I pay first and then get Medicare to reimburse me? Harvey Dear Harvey, It depends on your doctor and on whether your doctor accepts Medicare's payment as payment in full (this is known as "accepting assignment"). If your doctor accepts assignment: he or she can ask you to pay only the 20 percent coinsurance (50 percent for mental health services) up front (and your Part B deductible if you have not yet reached it-$135 in 2009). Your doctor files the claims, and Medicare pays the doctor directly. If your doctor does not accept assignment: your doctor may ask you to pay the full amount for services in advance and charge you up to 15 percent more than Medicare's approved amount under federal law (balance billing). Some states have stricter limits on what your doctor can charge you. Medicare will reimburse you directly for its part of the bill (80 percent of Medicare's approved amount for most medical services; 50 percent for mental health services). Marci Dear Marci, The hospital my father is staying in wants to discharge him. He feels that he is not ready to leave and that they want him to leave too soon. Is there anything we can do? Natalia Dear Natalia, If your father feels he is being asked to leave the hospital before he is well enough to go, he can ask for an immediate (expedited) independent review of his case. It is a good idea to ask a doctor (treating physician would be best) for support. Before being discharged, your father should receive a notice called an "Important Message from Medicare" that describes his rights as a patient as well as how to request an immediate review. (If he was in the hospital for more than a couple of days, he should have received this same document within two days of being admitted to the hospital.) If your father makes his formal request within the proper timeframe by midnight on the day he is supposed to be discharged the hospital cannot force him to leave before a decision has been reached. He should be able to stay in the hospital for a few extra days at no charge while his case is being reviewed. Even if it is decided that your father does not need to stay in the hospital, he cannot be charged for any care he receives until noon of the next calendar day after he receives the review decision. Marci Marci's Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation's largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe to "Dear Marci," MRC's free e-newsletter, e-mail dearmarci@medicarerights.org. To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center's website at www.medicareinteractive.org.