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You are here: Experts > Health/Fitness > Health Care: UK > Medicare, Medicaid, Insurance, HMO problems > Non-medicare provider
Expert: John Pedit - 10/30/2009
Question
Hi,
Recently my wife chose to work with a psychologist who does not accept payment from third parties. The psychologist has an NPI number. My research (on-line and phone calls to Medicare) indicated that she could work with this psychologist and that we would have to submit a 1490S Form (Patient's request for Payment). We realize the amount billed by us to Medicare would only be partially covered (based on Medicare assignment amounts). We just received a notice from Medicare saying "the provider was not covered by Medicare when you received this service".
My question: Can Medicare patients work with non-medicare providers and bill Medicare directly using the 1490S form? Or is this not even the right question to ask? Any other suggestions or references would be appreciated.
Answer
Hi Tom
I am not a lawyer and this is bordering more of a legal question than a Medicare question.
A provider needs to have a contract with Medicare to be covered by Medicare. Then they can either accept assignments or not accept assignments. Thus he is bound by Medicare regulations.
So if they have been advised that the provider does not have a contract with Medicare, and therefore is not covered by Medicare at the time of the service, they have in effect entered into a private contract with the provider and agreed to pay for the services. Medicare will not pay.
Suggest you talk with an elder lawyer regarding this.
John
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