Traditional Medicare Physician Balance Billing and Private Contracting

The Centers for Medicare & Medicaid Services should closely monitor and vigorously enforce balance-billing limits.

Congress should not expand private contracting for physician services.

Physicians who privately contract with beneficiaries for Medicare-covered services should continue to provide patients with complete information on:

• the physician’s status as a provider who does not accept Medicare payment;
• the lack of Medicare coverage for services provided under the contract, the availability of Medicare payment if the services were provided by a physician who accepts Medicare payment;
• the lack of balance-billing limits on charges for those services; and
• the cost of the service, the non-applicability of supplemental coverage for contracted services.