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Were you involved in a Virginia car accident, you used Medicare to pay your bills, and now your health care provider is asking for more money beyond what Medicare paid? If so, this is called “balance billing,” and it may be illegal. 

Under Medicare rules, generally, if a health care provider agrees to accept Medicare, they are limited to what Medicare pays them. (In some instances, they can get more, but it’s very specific circumstances, and they can only recover 15% more). While you may have to pay additional co-pays or co-insurance, the provider usually cannot then ask you to pay additional money for their services.

If they do, you should do a couple things:

  • First - Contact the provider and ask to clarify the bill. If they accepted Medicare payment for your treatment, tell them that you understand Medicare rules don’t allow them to get more money from you.
  • Second - If they persist, ask them to send their request to you in writing so that you can have an attorney review the bill.
  • Third - You can then give us a call and we will take a look. 

Medicare does allow for reporting of improper billing; however, sometimes mistakes are made. So I'd reach out first to see if you can't get it resolved simply. However, don’t assume it’s right simply because you’re not an “expert.” Many "experts" actually have no idea what they are talking about. And others knowingly take advantage of those less versed in medical billing.

Also, make sure to review your bills and Medicare explanation of benefits to make sure there are no additional issues with your bills. 

For more information, check out this pamphlet created by Medicare for patients.

Brian Glass
Virginia personal injury lawyer selected to SuperLawyers Rising Stars List and the NTLA's Top 40 Under 40.