Traditional Medicare Patients

Traditional Medicare Patients

MacGregor Family Physicians, PA (MACFP) is not a certified Medicare provider and does not accept assignment from Medicare.If you are on traditional Medicare we will collect the Medicare allowed amount at the time of service. We will electronically file the claim to Medicare on your behalf. We do not accept assignment from Medicare, which means if there are funds to be reimbursed for your visit, they will come directly to you, instead of our office. Our office policy is that you are required to pay the Medicare allowed amount at the time of service. Medicare will reimburse you at 80% once your deductible is met. Therefore, you need to pay the allowed amount in full at the time of your visit.

Medicare Advantage Plans

MACFP does not accept assignment or file claims to Medicare Advantage Plans. This means you will pay the Medicare allowed amounts at the time of service. Within five days you will receive a CMS billing form that you must submit to your insurance to seek reimbursement.You are encouraged to keep a copy of your encounter form to submit with the billing form. For reimbursement issues patient must contact their insurance company. MacGregor Family Physicians is considered an ‘OUT OF NETWORK’ provider with ALL Medicare Advantage plans, check your benefits.

Fees/Allowed Amounts

Every Medicare patient who is seen in our office is charged by the Medicare Fee Schedule. This fee schedule is generated by Medicare. When your visit is completed, you will be asked to pay the Medicare allowed amount for the services you received. Any lab work performed will be billed directly to Medicare by Quest Diagnostics.

Routine Physical

MACFP is not a participating provider with Medicare and does not accept assignment. Therefore, your yearly routine physical must be paid in full at the time of service. MACFP does not perform Welcome to Medicare or Medicare Annual Wellness Visits. If you are 65 years or older and desire a complete physical exam the fee is $285.00

Secondary Insurance Billing

If you have a secondary/supplemental insurance, please inform Medicare and they will electronically forward your claim. It is your responsibility to contact Medicare with your secondary/supplemental insurance information. MACFP does not bill secondary/supplemental insurance companies.