Medicare and making the most of your doctor visits

Obtaining the best health care involves good communication between you and your doctor. Today I will help explain how you can build an effective relationship with your doctor and make the most of your visits.

Communicate well with your health care provider

Communication is very important when building relationships with your health care providers and getting the best possible care. To help you communicate with your providers, take the following steps:

Be prepared. Arrive at your doctor’s office prepared with your health insurance cards, a copy of your health history if you’re a new patient, and a list of questions you want to ask your doctor. Bring something to take notes on what your doctor tells you. To assist, consider bringing another person, like a family member, friend or caregiver.

Share information. Tell your doctor about symptoms you’re having and any trouble you’re having with activities of daily living. Share about other providers you’ve seen and any treatments they recommend.

Ask questions. If you don’t understand something your doctor says, ask them to explain again in a different way.

Get it in writing. Ask your doctor to write down what you should do between now and your next visit, including instructions for how to take medicines, specialists you should see, or lifestyle modifications.

Follow up. If you experience any issues after your appointment, call your doctor’s office to schedule a follow-up. Ask your doctor’s office if they use email or an online portal to communicate with patients.

Advance Beneficiary Notice

If your provider believes that Medicare will not pay for a service, they may ask you to sign an Advance Beneficiary Notice (ABN) before you receive that service. The ABN allows you to decide whether to get the care — and pay out of pocket for it — if Medicare denies payment. The notice must list the specific reason why the provider believes Medicare may deny payment. Providers are not required to give you an ABN for services or items that are never covered by Medicare, such as hearing aids or dental care. Medicare requires providers to only use ABNs on a case-by-case basis. Providers cannot have a blanket ABN policy where they provide an ABN for all services.

Seek a second (or third) opinion if needed

A second opinion is when you ask a doctor other than your regular doctor for their view on your symptoms, injury or illness to better help you make an informed decision about treatment options. Medicare covers second opinions if a doctor recommends that you have surgery or a major diagnostic or therapeutic procedure, such as something that would require general anesthetic. Medicare will cover a third opinion if the first and second opinions are different from each other. The second and third opinions will be covered even if Medicare will not ultimately cover your procedure. Note that Medicare does not cover second and third opinions for excluded services, such as cosmetic surgery.

Billing errors sometimes happen

Doctors and their billing departments can make errors or honest mistakes when billing. You can spot these errors by reading your Medicare statements and comparing them to your own records. The Medicare Information Office offers “My Health Care Trackers” for this purpose. If something doesn’t seem right, call your provider. For example, you may see that your provider billed Medicare for an office visit on a day when you did not see them. Or, you may see that your provider billed you for a service that seems different than what you actually received. If they made a billing error, they should correct it. If your provider does not fix the error, or if you notice a pattern or errors, contact our office. One of our certified counselors can help you identify Medicare fraud, errors or abuse, and help resolve your concern.

Here to help

For any Medicare related questions, please feel free to contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680. Our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program. If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office.  Call us to inquire about our new Ambassador program.

Sean McPhilamy is a volunteer and Certified Medicare Counselor at the Alaska Medicare Information Office.

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