Latest news with #urgentcare
Health Line
3 days ago
- Business
- Health Line
What to Do If Your Doctor Doesn't Take Medicare
If a doctor doesn't accept Medicare, you can choose to see them and pay more, or you can find a different provider. Medicare has an online directory of participating providers. When you're enrolled in Medicare and looking to get medical care, it's important to check whether the healthcare professional you want to see is willing to work with the insurance program. Many doctors work with Medicare. Those who do not may be nonparticipating providers or opt-out providers. Nonparticipating providers may sometimes accept assignment, but they may not at other times. Opt-out providers never accept Medicare. Read on to learn what to expect and what to do when your doctor will not take Medicare. What happens if a doctor doesn't accept Medicare? A doctor who works with Medicare is referred to as accepting assignment. This means the provider is willing to accept Medicare reimbursement. If you see a doctor who does not accept assignment, you'll have higher out-of-pocket costs than with a participating provider. In this case, your choices are as follows: See a different doctor: Switch to a different doctor who works with Medicare. Go to urgent care: Depending on your medical needs, you could schedule an immediate care or walk-in visit with a doctor who accepts Medicare. This may be easier and faster than scheduling a regular appointment. Most urgent care centers should accept Medicare. You can speak with the care center staff to learn whether the facility accepts Medicare. Proceed and pay extra: You might make this decision, for example, if you need to see a specific specialist and no similar specialist is accepting assignment. In this case, you can consider asking the staff if there are any discounts or payment plans that you might be eligible for. Submit claim: If you do proceed with seeing a nonparticipating doctor who does not accept assignment, they will submit a claim for any portion of the service they will directly bill to Medicare. In some cases, you may be asked to pay upfront and submit the claim yourself. How much does it cost to see a doctor who doesn't accept Medicare? Medicare nonparticipating providers can choose individually whether to accept the Medicare-approved rate for covered services. This amount is what Medicare reimburses them for services under Medicare Part B. If they do not accept this rate, they can charge you up to 15% more than the approved rate. The exact percentage varies by state and is called the 'limiting charge.' Note that this surcharge rule does not apply to durable medical equipment (DME), which means DME suppliers can charge more than the limiting charge. When it comes to opt-out providers, since they do not accept Medicare at all for any service, they will bill you directly for all costs unless you have a secondary health insurance plan that they do accept. Is it hard to find doctors who accept Medicare? It's not difficult to determine whether a doctor works with Medicare. To find out if a doctor accepts Medicare assignment, consider asking your current doctor's office for a referral to someone who does accept assignment. You can also use the Medicare provider directory on the website. Alternatively, you can call 800-MEDICARE (800-633-4227) or the specific doctor's office and ask before you schedule the appointment. In addition, representatives from the State Health Insurance Assistance Program (SHIP) may be able to assist you in the search. Why would a physician opt out of Medicare? Whether to accept an assignment depends on each doctor or clinic. Doctors who opt out of Medicare can set their own fees and avoid Medicare billing rules, audits, prior authorizations, and documentation requirements, gaining greater flexibility and reducing their administrative responsibilities. Nonparticipating providers, in particular, can decide on a case-by-case basis whether to accept Medicare rates or bill you directly at higher rates for certain services. In high cost areas or when their patients indicate that they can pay out of pocket, nonparticipating providers may earn more than participating providers when they don't accept assignment. On the other hand, when nonparticipating providers file a Medicare claim, they receive a payment that is 5% lower than the amount permitted by the Medicare physician fee schedule. This means they earn less than participating providers when they consent to accept assignment. Frequently asked questions What percentage of doctors do not accept Medicare? As of 2024, only about 1% of non-pediatric physicians had opted out of Medicare altogether, with psychiatrists leading at 8.1%. Opt-out rates are notably low for emergency medicine, oncology, radiology, and pathology, all at 0.1% or less. Psychiatrists, on the other hand, make up the largest portion of those opting out, followed by family and internal medicine physicians. As of 2024, only about 1% of non-pediatric physicians had opted out of Medicare altogether, with psychiatrists leading at 8.1%. Opt-out rates are notably low for emergency medicine, oncology, radiology, and pathology, all at 0.1% or less. Psychiatrists, on the other hand, make up the largest portion of those opting out, followed by family and internal medicine physicians. Do doctors have to accept Medicare Advantage plans? When considering nonparticipating versus opt-out providers, remember that these terms refer to doctors who may or may not accept Original Medicare (parts A and B). In addition, you have the option to enroll in a Medicare Part C (Medicare Advantage) plan instead, which would give you the same benefits. However, these are private insurance plans with their own network of providers. Depending on the type of plan, you may have to see an in-network provider. When considering nonparticipating versus opt-out providers, remember that these terms refer to doctors who may or may not accept Original Medicare (parts A and B). In addition, you have the option to enroll in a Medicare Part C (Medicare Advantage) plan instead, which would give you the same benefits. However, these are private insurance plans with their own network of providers. Depending on the type of plan, you may have to see an in-network provider. Why does Medicare pay less than the Medicare-approved amount? Every year, the Centers for Medicare & Medicaid Services (CMS) sets the rates for all physician services for the following year using a range of complex data sets and formulas intended to represent physician costs associated with practicing medicine, among other factors. That said, according to the American Medical Association, this formula does not adjust these rates for inflation, which may be another reason a doctor could decide to opt out of Medicare. Every year, the Centers for Medicare & Medicaid Services (CMS) sets the rates for all physician services for the following year using a range of complex data sets and formulas intended to represent physician costs associated with practicing medicine, among other factors. That said, according to the American Medical Association, this formula does not adjust these rates for inflation, which may be another reason a doctor could decide to opt out of Medicare. Do all doctors accept Medicare Supplement plans? Medicare supplement plans, also called Medigap, can be easily confused with Medicare Advantage. Doctors do not accept Medigap simply because it is not a medical insurance plan. Instead, Medigap helps cover remaining costs after Original Medicare coverage kicks in. Medicare supplement plans, also called Medigap, can be easily confused with Medicare Advantage. Doctors do not accept Medigap simply because it is not a medical insurance plan. Instead, Medigap helps cover remaining costs after Original Medicare coverage kicks in. Takeaway When you are enrolled in Original Medicare and need medical attention, it's crucial to verify whether the healthcare professional you wish to visit collaborates with the insurance program. Numerous doctors partner with Medicare, but some may not. Per Medicare guidelines, they are referred to as nonparticipating providers or opt-out providers. Nonparticipating providers might occasionally accept Medicare assignment, while opt-out providers never do. If a doctor does not accept Medicare, you have the option to still see them, but you will likely incur higher costs. You can also see a different provider. Medicare provides an online directory listing participating providers.
Yahoo
4 days ago
- General
- Yahoo
Temple Police Investigate Aggravated Assault That Injured Three
Temple, TX (FOX 44) – Around 3:47 Saturday morning, Temple Police responded to the 800 block of E French Street after hearing gun shots. Upon arrivals officers reported seeing people exiting the area on foot and in their vehicles. According to witnesses, there was a physical altercation which led to an individual firing a weapon. Although police did not locate any victims at the scene, contact was later made with two victims at a local hospital. The victims were described to have non-life-threatening injuries related to a physical altercation. Around 5:40A.M. a gunshot victim arrived at a nearby urgent care facility. Their injury is non-life-threatening and consists of an injury to an elbow. This case is under investigation. Anyone with information should contact the Temple Police Department at 254-298-5500 or the Bell County Crime Stoppers at 254-526-8477 Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
BBC News
29-05-2025
- Business
- BBC News
Hywel Dda health board's fragile services need urgent change
Hospital services across a Welsh health board could reorganised because they are so Dda health board has included critical care, stroke services, eye care and urology among those in need of urgent the options would be to halve the number of acute stroke units and centralise planned urology cases and eye care.A number of options will be given to the public, though the health board said it would welcome alternative suggestions as there was no preferred is understood each option put forward would come with a cost implication, but would be less than the current rising costs. Hywel Dda said changes were needed "because of the risks to them being able to continue to offer safe, quality services or timely care".The four main hospitals in the area, which covers Pembrokeshire, Carmarthenshire and Ceredigion, are Prince Philip in Llanelli, Glangwili in Carmarthen, Withybush in Haverfordwest and Bronglais in health board said clinical teams were spread across multiple sites, over a wide geographic area, and there is an "over-reliance on a small number of individuals".The nine areas deemed most fragile are: Critical careDermatologyEmergency general surgeryEndoscopyOphthalmologyOrthopaedicsRadiologyStrokeUrology The health board is not alone in facing challenges of reducing waiting times for a time when parts of Wales still have patients waiting longer than two years for care, it has removed those waits entirely, but still has more than 12,000 waiting longer than one issues have improved predominantly due to the recruitment of international nurses, taking band five vacancies down from 280 whole-time equivalent to just health board said that had substantially reduced its agency spend, but vacancies remained in other areas of its to update services were first drawn up in 2018 and while the pandemic increased demand, Hywel Dda has also had to contend with significant capital costs associated with issues around reinforced autoclaved aerated concrete (Raac) at Withybush Hospital.A new hospital is planned for the area, but will not be built for at least 10 years after delays as well as the impact of inflation on construction costs. Since the pandemic, there has also been an increased emphasis on regional working among health boards in Wales, meaning pressures can be spread across regions, though that also creates fresh logistical backlog maintenance costs for an ageing estate continuing to rise, meaning doing nothing is not an option.A previous report stated maintenance costs had increased from £60m to £255m since 2018, with £42m categorised as "high risk". Glangwili and Withybush have the "most significant backlogs" at £90m and £72m changes would be closely inspected by patients who are likely to face longer travel times for some services as a consequence, though the plans also include expansion in some areas and a greater role for primary and community services.A public consultation on the options will be held over the summer with final plans expected to be put to the board by November.
BBC News
29-05-2025
- General
- BBC News
South Yorkshire mental health text support scheme launched
A new service has been launched in South Yorkshire offering urgent mental health support by text partnership between NHS South Yorkshire and digital mental health service Shout, created by the Mental Health Innovations charity, will offer free support 24 hours a charity said it would help patients access anonymous and confidential help without having to wait for a face-to-face or telephone South Yorkshire chief medical officer Dr David Crichton said: "We know that some people are uncomfortable seeking face-to-face support for mental health issues, so the option to have a text conversation encourages more people to reach out for help." The service is accessible by texting "EYUP" to the given phone number, an idea by Sheffield-based children and young people charity Hornby, CEO of Mental Health Innovations, said: "By offering Shout as part of the ICB's [integrated care board] range of services, we can help take the pressure off face-to-face and phone services, while ensuring that people in distress can access urgent support."We know that reaching out for help can be difficult, and texting provides an accessible and discreet way for individuals to seek help whenever they need it." Listen to highlights from South Yorkshire on BBC Sounds or catch up with the latest episode of Look North.
Associated Press
24-05-2025
- Health
- Associated Press
Community Health Provider Aims to Make Health Care More Accessible
Dallas, TX May 23, 2025 --( )-- Memorial Day is a time when the nation pauses to honor the courage of our heroes, including those who may struggle silently, and to reflect on the toll that mental health challenges can take—especially on families, veterans, first responders. It is a day that can weigh heavy on people's minds, and it seems more and more of us need help in coping these days. As the topic of mental health comes front and center, one particularly acute area of concern is the increasingly unmet behavioral health need in some communities. A More Accessible Model for Behavioral Health As of the latest available data, rural counties in the United States face significant shortages in mental health professionals, as indicated by Health Professional Shortage Area (HPSA) designations (the definition used by the U.S. Department of Health and Human Services) – approximately 81% of rural counties are considered underserved for mental health care. The cry for mental health care is getting louder and louder. One provider in Texas and Missouri, Total Point Healthcare ( ), is trying to make more forms of healthcare more affordable and more accessible in underserved communities. The organization prides itself on patients never having a long wait for Urgent Care. Its primary patient clientele are often modest income families in smaller communities. In a fitting tribute to Behavioral Health month in May, the company is announcing its newest offering: Total Point Behavioral Health Care services. These days, Behavioral Health often involves seeking expensive specialists, typically booked months in advance. But Total Point offers Behavioral Health services for often just half the cost of some specialists. They also have a Wellness Membership plan that can lower the cost even more. That can make all the difference to families with modest means but facing serious mental health challenges. Karina Guffey, one of the company's Behavioral health providers in Springfield, MO, put it this way, 'When families have access to both mental and physical health care, it changes everything, and that makes our jobs all the more satisfying.' She added, 'We're working to bring compassionate, whole-person care to areas that have historically gone without. Mental Health services should be available everywhere, even the smallest communities – that's why we're doing this.' About Total Point Healthcare Total Point Urgent care offers Behavioral Health services in Springfield, MO, South Dallas, TX, and Jacksonville, TX, as well as via TeleVisit services, with further expansion of Behavioral Health services coming soon. Total Point operates Emergency Centers and Urgent Care and Primary Care clinics across Texas (Athens, Corsicana, Daingerfield, Dallas, Ennis, Hallsville, Jacksonville, Lindale, Mansfield and Whitehouse), and in Missouri (Branson, Hollister, Nixa and Springfield). For more information, visit or or contact Total Point Healthcare at [email protected]. Contact Information: Total Point Healthcare Marketing Team 469-251-7721 Contact via Email Read the full story here: Community Health Provider Aims to Make Health Care More Accessible Press Release Distributed by
