What is the meaning of an Actual Charge from a Medicare Health Provider?

The term "Actual Charge" refers to the amount that a healthcare provider, who accepts Medicare assignment, chooses to bill for a particular service or procedure. In the context of Medicare, "assignment" refers to the agreement between Medicare and healthcare providers to accept the Medicare-approved amount as full payment for covered services.

When a healthcare provider accepts a Medicare assignment, they agree to bill Medicare directly for the services provided to a Medicare beneficiary. Medicare then pays the provider the approved amount, which is typically less than the provider's actual charge. The difference between the provider's actual charge and the approved Medicare payment is known as the "balance billing" amount.

It's important to note that not all healthcare providers accept Medicare assignments. In such cases, providers may charge more than the Medicare-approved amount, leaving the beneficiary responsible for paying the difference in cost, which is known as "excess charges."

To avoid unexpected expenses, it's advisable for Medicare beneficiaries to confirm whether their healthcare providers accept assignment and understand any potential out-of-pocket costs associated with the actual charges or excess charges.

Actual charges can vary depending on the type of service, the provider's fees, and other factors. In some cases, the actual charge may be higher than the amount that the insurance company is willing to pay for the service. In these cases, the patient may be responsible for paying the difference, known as the balance or excess charge.

It is important for patients to understand the actual charges for medical services and procedures, as well as any potential out-of-pocket costs that they may be responsible for. Patients should review their insurance policies and discuss any questions or concerns with their healthcare providers or insurance companies to ensure that they have a clear understanding of their financial obligations.

MedHelpCenter.us recommends that you call the Senior Health Insurance Agency at 813-592-8568 for further explanation.