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About Merry Schiff
Expertise
I am very familar with Medicare and general insurance questions. I can answer general questions about HMO's.

Experience
I have been in the medical billing industry for 50 years. I have helped develop software for this industry. I am a consultant to billers and the medical profession.

Organizations
I am the Executive Director of NEBA, a medical billing organization with nearly 1000 members.

Education/Credentials
I have been teaching medical billing for many years as well as being a published author with Pearson Education. One book on medical billing (nearly 800 pages) and one on HIPAA.

You are here: Experts > Health/Fitness > Health Care: UK > Medicare, Medicaid, Insurance, HMO problems > medicare & hmo's & fee for service plan

Medicare, Medicaid, Insurance, HMO problems - medicare & hmo's & fee for service plan

Expert: Merry Schiff - 10/30/2009

Question
I am currently enrolled in Aetna Open Acess HMO with Medicare as primary. I STILL GET BILLS FOR physical therapy and specialist visits. Would these bills be eliminated if I joined a fee for service plan. I thought that by having both Medicare and other insurance I would be free of charges. What would be the best option for me?

Answer
I do not understand why you have Medicare and an HMO. Are you certain that you are not in an Advantage Plan, Medicare Part C. That is my gut feeling as Medicare does pay for PT with a doctor's referral. I do not believe that you have Original Medicare. And you are probably getting bills because you are not getting authorizations or are seeing providers outside of the HMO network

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