Vermont Statutes Title 33 Sec. 6503
Terms Used In Vermont Statutes Title 33 Sec. 6503
- Balance bill: means to charge to or collect from a Medicare or General Assistance beneficiary any amount in excess of the reasonable charge for that service as determined by the U. See
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Medicare beneficiary: means a person who is a beneficiary of health insurance under Title XVIII of the Social Security Act. See
§ 6503. Exceptions
The provisions of section 6502 of this title shall not apply and the physician may balance bill a Medicare beneficiary if:
(1) During the calendar year prior to treatment, the Medicare beneficiary (or his or her spouse with whom he or she lived at any time during that year):
(A) received Social Security benefits or railroad retirement benefits (Tier I treated as Social Security) that were subject to federal income taxation; or
(B) did not receive Social Security benefits or railroad retirement benefits (Tier I treated as Social Security) but, had such benefits been received, they would have been subject to federal income taxation.
(2) The Medicare beneficiary refuses to sign the statement authorized by section 6504 of this title; or
(3) The service for which the beneficiary is to be billed is either an office or home visit. Office or home visits are listed as procedure codes 90000 through 90170 in the Physicians’ Current Procedural Terminology, Fourth Edition (1986) published by the American Medical Association, as amended annually. Office or home visit codes for dentists, podiatrists, optometrists, and chiropractors shall be the same (or equivalent) procedure codes used for doctors of medicine or osteopathy. (Added 1987, No. 51, § 1.)