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Connect Your MedicareDr. Robert Specialist
Financial Breakdown
Coverage Details
This service is covered under your insurance plan. No deductible was applied to this claim. Medicare Coinsurance of $40.00 applies.
Cost Breakdown
Coverage Insights
- Provider is "Non-Participating" and does not accept assignment
- Excess charges of 15% applied above the Medicare approved amount
💡 These insights are derived from Medicare's adjudication data to help explain your coverage details.
AI Summary
Specialist visit with non-participating provider resulting in excess charges. The provider charged 15% above the Medicare approved amount, which is your responsibility. While the claim was approved, you paid $30.00 more than you would have with a participating provider.
Risk Flags
Insights
- •Check if your Medigap policy covers Part B excess charges (Plans F and G do).
- •For future visits, ask if the provider accepts Medicare assignment.
- •Search for participating Orthopedic Surgeons in your area to save on costs.
- •{"title":"Lower Your Costs: Assignment","url":"https://www.medicare.gov/your-medicare-costs/part-a-costs/lower-costs-assignment"}
- •{"title":"Medigap Costs and Coverage","url":"https://www.medicare.gov/supplements-other-insurance/how-medigap-works"}
Tags
Unilateral primary osteoarthritis, right knee
Primary osteoarthritis of the right knee. This is a degenerative joint disease causing pain, stiffness, and reduced motion.
Present on admission: No
Office/outpatient visit for the evaluation and management of a new patient
Office/outpatient visit
Office or other outpatient visit for the evaluation and management of a new patient. Typically 45 minutes are spent with the patient.
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