For medicare, Non-particpating providers must still follow the same rules as above. In order to be a “non-medicare provider”, in your terms, means opting out. If you do not contract with medicare (non-par) you are subject to the same rules. Failing to follow them is not a contract violation (tort), it is fraud, punishable in a criminal proceeding.

Currently, in order to opt out, you must sign an agreement with the local medicare contractor, that you will not accept payment from medicare, for any patients, for 2 years. Then, to propoerly bill patients, yo must contarct with the patient, in writing, your fees for all servcies, in advance.

If the patient does not contract, you cannot charge them. If you widh to opt-in - you must wait until the 2 years have expired.

Since the discussion is about health care, and not cosmetics, the plastic surgery comment is not relevant. If I opt out, and you ( a mediare recipient) would like me to attend to you in the hospital, or in my office, You must agree to my fee schecule, in advance and in writing, before I can charge you anything.

The most important point being, however, is that the assertion that the governement is making laws to limit how patient’s spend thier money really is not true. The laws are about contracts, and contracted providers, no patient’s, the patients are free to see non medicare providers and pay thier life savings out for plastic surgery if they wish.

If I provide a service which medicare will not pay for, and I have warned the patient, in advance and in writing, that medicare may not pay, then I can bill the patient. If I have not warned the patient in writing, in advance, I may not bill the patient.

If, on the other hand, I provide a service which medicare DOES pay for, and I charge more than medicare allows, I MAY NOT bill the patient for the balance. Medicare must deny the WHOLE CHARGE for the service before I can charge the patient, providing I have a signed ABN from the patient before providing the service.

So medicare recipients can get all the healthcare they want to pay out of pocket for, as long as it does not include services for which medicare pays anything.

“The bottom line is if you are a medicare provider you must first bill medicare and then be denied before you can pass the bill on to the patient.”

Wrong. I can only “pass the bill on to the patient” if I have a signed ABN, and medicare pays Nothing, nada, zilch. If I charge more for a service than medicare allows, and they pay, I cannot bill the patient the balance, regardless of my costs. So I may choose not to provide services for which my costs exceed what medicare allows. You have no right to force me to do so. You certainly have a right to find someone willing to provide the service, though.