I thought opting out of Medicare assignment meant not having to operate according to Medicare guidelines. Or are you saying there are laws forcing them to file to any and all insurance entities?
If that's true, it's good information to know in the case of Medicare approved services. Maybe one could negotiate a good "pay as you go" discount with the provider and get full coverage upon Medicare reimbursement.
I think the Weisenthal statement indicates Medicare doesn't , or doesn't always, consider their services appropriate for coverage.
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" erratic coverage patterns"
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So filing might not guarantee reimbursement.