Private Pay Option for Medicare Services

     Some patients may choose to private pay any treatment to ensure their confidentiality without permanently leaving the Medicare program.  Patients not wanting their medical history to be used against them in legal cases or embarrassing situations relating to sexual impotence or sexually transmitted diseases.  Private pay is relatively common involving mental health services.

     Practices, especially those that perform routine procedures where confidentiality is not usually a concern, may need to worry about violating Medicare rules by not submitting a claim for a covered service.  It is required to respect a patient's right to temporally waive Medicare benefits.  Patients who opt for private pay generally do so for all services performed in a certain specialty or course of treatment.  Billing can become confusing if an established Medicare patient chooses to be personally billed for a new series of treatments.  Keeping separate accounts for charges billed to Medicare and of those privately billed for an established patient may reduce the chance of accidental release of information to Medicare that a patient wants to keep private.

     When a patient does elect to private pay and does not want a Medicare claim filed it is advised to have the patient sign a waiver at the beginning of a visit, documenting that the patent has chosen not to have Medicare billed and it is their responsibility for payment of charges incurred that day.  According to Daniel Gottlieb, a health care attorney with McDermott, Will & Emery in Chicago, the waiver should state "any services provided outside of Medicare will be subject to the physician's normal fee schedule."  It is also recommended to workout a payment plan in advance with a private pay option patient.  Practices are limited in what they can charge a patient when privately billing a Medicare patient for services that would normally be covered by Medicare and should contact Medicare for more specific information.