NCPA - National Center for Policy Analysis

Court Rules Patients Can Pay For Services Not Covered By Medicare

July 27, 1999

For several years, federal regulations have prohibited doctors from providing private care to Medicare patients -- called private contracting. A doctor who provides services Medicare covers, but is reimbursed by the patient is barred from filing another Medicare claim for two years.

But that has now changed.

  • A July 16, 1999, decision by the U.S. Court of Appeals for the District of Columbia "rendered useless" a section of the Balanced Budget Act of 1997 which permitted the rule.
  • A suit filed by the United Seniors Association Inc. against the Department of Health and Human Services charged that that section of the act was unconstitutional and harmful to seniors because it effectively prevented Medicare beneficiaries from using their own money to pay for their own health care.
  • Doctors were unwilling to contract privately with Medicare recipients to provide certain services and tests because they feared banishment from Medicare.

Physicians have reported being deluged by threatening letters from the Health Care Finance Administration -- which administers Medicare -- when they accepted private payments from seniors.

An official of the United Seniors Association called the decision "the most sweeping pronouncement ever made by any court on the subject of Medicare beneficiaries' access to health care" -- adding that the victory was "a huge win for seniors."

Source: Joyce Howard Price, "Court Says Medicare Patients Can Pay for Uninsured Care," Washington Times, July 25, 1999.


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