Tuesday, 06 December 2022

Opinion

Greg Dill, Medicare’s regional administrator for Arizona, California, Hawaii, Nevada and the Pacific Territories. Courtesy photo.

Most doctors accept Medicare as full payment for their services. But some accept it only for certain services, and others don’t accept it at all.

What does this mean for you?

If you have Original Medicare, it means you should try to use doctors, hospitals, medical equipment suppliers, and other healthcare providers that participate or “accept assignment” in Medicare. Such providers have signed agreements to take Medicare as payment in full for their services.

If your doctor or other provider accepts assignment:

Your out-of-pocket costs may be less.
– The provider agrees to charge you only the Medicare deductible and coinsurance amount, and usually waits for Medicare to pay its share before asking you to pay your share.
– The provider has to submit your claim directly to Medicare and can't charge you for submitting the claim.
– Some doctors and other providers haven't signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for some services. – These providers are called "non-participating" providers.

If your doctor or other provider doesn't accept assignment:

– You may have to pay the entire bill at the time of service. Your provider is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you.
– The provider can't charge you for submitting a claim. If they don't submit the Medicare claim once you ask them to, call 1‑800‑MEDICARE.
– In some cases, you might have to submit your own claim to Medicare using Form CMS-1490S to get paid back.
– The provider can charge you more than the Medicare-approved amount, but there's a limit. Non-participating providers are paid 95% of the Medicare-approved amount. They can only charge you up to 15% over the amount that non-participating providers are paid.
– The 15 percent limit applies only to certain Medicare-covered services and doesn't apply to some medical supplies and durable medical equipment.

Some doctors and other providers don’t want to enroll in the Medicare program at all. You can still visit these “opt out” providers, but they must enter into a private contract with you (unless you’re in need of emergency or urgently needed care).

A private contract is a written agreement between you and a doctor or other provider who has decided not to provide services to anyone through Medicare. The private contract only applies to services you get from the provider who asked you to sign it.

If you sign a private contract with an opt-out doctor or other provider, keep in mind that Medicare won't pay any amount for the services you get from that provider, even Medicare-covered services.

– You'll have to pay the full amount this provider charges you. You and your provider will set up your own payment terms through the contract.
– If you have a Medicare Supplement Insurance (Medigap) policy, it won't pay anything for the services you get. Call your insurance company before you get the service if you have questions.
– Your provider must tell you if Medicare would pay for the service if you got it from another provider who accepts Medicare.
– Your provider must tell you if he or she has been excluded from Medicare.
– You can't be asked to sign a private contract for emergency or urgent care.
– You're always free to get services not covered by Medicare if you choose to pay for them yourself.
– You don't have to sign a private contract. You can always go to another provider who participates (accepts assignment) in Medicare.

Be sure to ask your physician or other provider if they are participating, non-participating, or opt-out. You can also check by calling 1-800-MEDICARE or by using Medicare’s Physician Compare tool on www.medicare.gov .

You may want to contact your State Health Insurance Assistance Program (SHIP) to get free help before signing a private contract with any doctor or other health care provider.

Greg Dill is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

The story of the wise men visiting the Christ child is an intriguing one.

These men began a long trip to Israel simply because a particular star was in the sky, alerting them to the birth of the king of the Jews.

They traveled for several months perhaps even as many as two years to finally meet the Christ child in person.

I believe it is more than just a story meant to entertain us, it is meant to teach us something today, about seeking the Christ child. For God will reach to the end of the earth to call all people to worship Jesus.

Unbeknownst to many, the Wise Men from the east weren’t there in the stable. They hadn’t even left their homes yet.

But because of the lingering myths that exist about these men of gentile origin, it’s hard to find a nativity scene anywhere in the world that doesn’t have these three visitors from the East huddling by Jesus’ bedside, giving their gifts and proper worship to this One who was born King of the Jews.

As we ponder the view of the nativity scene, rather than say it is wrong, let’s instead marvel at the way in which Jesus’ birth took the whole world captive in its meaning and purpose. The people close by like the lowly shepherds and to those at the edges of the known world, the prominent and wise men.

On that first Christmas night, God announced His Son’s birth, not to top-level dignitaries or theologians, but to lowly shepherds – men who were completely undeserving of receiving such a splendid Divine revelation as this one.

The presence of the shepherds on Christmas Eve, then, is a wonderful sign of God’s grace to those who are near Him, a sign which says that it really doesn’t matter who you are, how important you are, or how respected you are in the eyes of the world.

No matter what your standing is in this world, the Good News is that God has sent His Son into the world for you and me – sent His Son to save us from His wrath and condemnation – sent His Son to take away the guilt of our sin, and to love us with an everlasting love.

In comparison, as we look at the coming of the Wise Men from the East, what we see is that the Gospel not only extends itself to those who are nearby, but also to those who are far away. We might even say that this Gospel comes especially to those who are least likely to hear and receive it.

The Wise Men, weren’t notable kings from the East who had come to visit another noble from the West, rather these men were scientists, perhaps very well off, but for all intents and purposes, pagans who’d been touched by the universal outreach of the Gospel of this King who was born beneath the Star in Bethlehem.

This is how God works His miracle of communicating the Gospel of grace in outreach to all people near and far.

Join us this Sunday to hear more about the Epiphany event where Jesus’ Divinity was made manifest to the gentile nations.

This week we have a guest speaker, Bob Hamilton, who will lead worship.

Service begins at 11 a.m. with lunch immediately following worship.

Please come as you are – all people are welcome.

Chris DelCol is pastor of First Lutheran Church in Lucerne, Calif. The church is located at 3863 Country Club Drive, telephone 707-274-5572. Email Pastor Chris at This email address is being protected from spambots. You need JavaScript enabled to view it..



Imagine going to the grocery store, picking up the items you need for the week, but not knowing how much anything costs until the store sends you a bill two weeks later.

Sadly, that’s how our healthcare system works every day.

Healthcare costs now represent one in every five dollars spent in our country. Patients’ deductibles and copays are rising. Prescription drugs are often unaffordable for many Americans.

We must do something about rising costs, and one key is to empower patients with the information they need to drive costs down and quality up by making the healthcare system compete for their business.

That’s why Medicare recently launched a new online tool that allows consumers to compare Medicare payments and patient copayments for certain surgical procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.

The Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center. It also shows the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.

Working with their doctors, people with Medicare can use the Procedure Price Lookup to consider potential cost differences when choosing among safe and clinically appropriate settings to get the care that best meets their needs. And cost differences can be substantial.

The lookup tool is needed because the law requires Medicare to maintain separate payment systems for different types of healthcare providers. That means Medicare pays sharply different amounts for the same service, depending on the locale of the care. It also means that people with Medicare pay different co-pays for the same service, depending on where it’s delivered.

Unfortunately, this is a prime example of Medicare’s misaligned financial incentives, under which providers can make more money if they treat patients at one location as opposed to another. Here’s an example: a Medicare beneficiary needs knee surgery, and her surgeon offers her the choice to have the surgery in the local hospital’s outpatient department or at an independent surgery center.

With the Procedure Price Lookup tool, the beneficiary can type in the type of surgery and see an estimate of the difference in out-of-pocket costs between the two settings.

It would take an act of Congress to change Medicare’s payment systems. In the meantime, patients have the right to at least know what they will be charged. The Procedure Price Lookup makes that information easy to access.

Procedure Price Lookup is part of our eMedicare initiative and joins other patient-oriented transparency tools, including an overhauled version of our drug pricing and spending dashboards. These new tools provide patients with Medicare and Medicaid spending information for thousands more drugs than ever before and, for the first time, list the prescription drug manufacturers that were responsible for price increases.

We launched the eMedicare initiative to empower beneficiaries with cost and quality information. eMedicare also offers a mobile-optimized out-of-pocket cost calculator to provide beneficiaries with information on overall health plan costs and prescription drug costs.

The case for price transparency throughout the healthcare system is clear. The need for consumers to comparison-shop is growing as high-deductible plans become the norm. We also need to integrate quality information with price transparency, so consumers are empowered to seek out high-value care among providers competing on both cost and quality.

Greg Dill is Medicare’s regional administrator for Arizona, California, Nevada, Hawaii and the Pacific Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

In Jesus’ baptism was a sign for Jesus as well as John the Baptist that God had indeed chosen Jesus to be his incarnate presence in this world.

Jesus’ baptism was an epiphany event, a manifestation, a light and a revelation of God’s presence in this world.

In baptism, we too become God’s chosen ones. In the pouring of the water and in the saying of the words, we become God’s children. We are chosen by God. He acts, He comes to us through the water and the Word to make us His.

The baby or adult being baptized will have no active part, that is because God is the one who acts. God comes to the person and claims them for His own. God does all the action in baptism. God claims the person’s life for eternity.

A pastor stood by the grave side of a young mother with her husband and three children. The husband looked into the eyes of the pastor and demanded, "Now tell me what you really believe, Pastor, is this the end of everything, the way God meant it to be?"

The pastor said, "It’s not what I believe that matters, you have the answer in your heart. You know deep in your heart, this is not the end. You haven’t stopped loving your wife. Do you think God has? You know that life with God is eternal. God gave you that faith. All YOU have to do is believe what your heart already knows."

Yes, the claim upon us in baptism is for eternity. In our baptism, we are also anointed with the Spirit. A sign of the cross is made to seal the covenant agreement made through the water and the word.

Our sins are forgiven as it says in Titus 3:5, “He saved us not on the basis of deeds which we have done in righteousness, but according to His mercy, by the washing of regeneration and renewing by the HoIy Spirit.”

Our sins are forgiven, and at the same time, we agree to fight against sin and to confess our sins daily to God so He will drown them and raise out of the waters of our Baptism a new person.

Baptism is not a magical rite, but in baptism an agreement is made between us and God. This agreement is for a lifetime.

We ask God to cleanse us and renew us each day in the waters of our Baptism. That is not to say we need to be baptized each day, but each day we relive our baptism in that God drowns our sinful selves and raises up a new person.

So, baptism happens once, but we must live in it daily. And if we don’t keep our part of the agreement, to confess our sins, to seek God’s forgiveness, then the promise of baptism means nothing, because in our forsaken selves, we also turn away from God’s action of forgiveness.

Please join us this Sunday, Jan. 13, to hear more about Jesus’ baptism and how this sacrament is a promise of eternal life to all who believe.

Worship is at 11 a.m., followed by lunch. All are welcome so please come as you are.

Chris DelCol is pastor of First Lutheran Church in Lucerne, Calif. The church is located at 3863 Country Club Drive, telephone 707-274-5572. Email Pastor Chris at This email address is being protected from spambots. You need JavaScript enabled to view it..

The new year has arrived, which means it’s time to start planning your finances accordingly.

New data from Principal Financial shows that more than half of the people surveyed (56%) are optimistic about the economy in next year.

“There’s no one-size-fits all magic bullet for spending versus saving. However, the more we can think about spending and saving instead of spending or saving, the better off people will be,” said Jerry Patterson, senior vice president of retirement and income solutions at Principal. “Taking a hard look at where we missed the mark and committing to making the right changes is a key step for 2019 well-being.”

Some of the top financial New Year’s resolutions in 2018 included saving more each month (46%), reducing spending each month (38%), paying off credit card debt (29%), building an emergency fund (24%), and saving more for retirement (21%) according to Principal Financial.

If you are looking to create a budget or get out of debt in the new year, BBB has tips and tools to help you get on the right track to a better financial future:

· Calculate your income. You can't properly set a financial resolution unless you know what you're working with. Calculate your monthly net income, which is after taxes, so you can set a clear budget with exactly what you are bringing home.

· Track your spending. Whether you prefer an app on your phone, computer software, or simply a notebook to jot down your expenses, keeping track is critical. It helps you see where you are actually spending your money, rather than where you think you are.

· Categorize your spending. Create categories based on necessities (housing, utilities, food, transportation) and luxuries (entertainment, dining out, travel). If you have credit card balances, student loans, car payments or other debt, make “debt reduction” one of your necessary categories. Here are some additional tips on how to pay less in some of those categories.

· Set up a budget. Once you have an idea where you are spending money, you can set up a realistic budget. There are free online tools to help you, so there is no need to spend a lot of money. Be cautious of scams, however, and never share personal identifying information (PII) unless you are sure of the site’s legitimacy.

· Pay down debt. One method is to pay off the credit account or loan with the highest interest rate first (the “ladder method”). Another is to pay off the smallest balance first so you feel a greater sense of accomplishment (the “snowball method”). Use whichever methods works best for you. The important thing is that you are doing it. Also, call your credit card company and ask if they will lower your interest rate. Some lenders will agree just to keep you from transferring your debt to another lender with better terms. If you shave even a few percentage points off of your rate, it can help you save and pay down your balances faster.

· Pay bills on time. Consider online bill-paying that eliminates writing checks, buying stamps, etc. Automatic payments can be scheduled ahead of time and can help you avoid late fees and penalties for missed payments.

· Save for the big things. Big purchases, such as vacation or holidays, can easily blow your budget. Avoid going into debt for these expenditures by saving up ahead of time and only spending what you are able to save. Many banks and credit unions offer savings clubs that might help.

· Save for emergencies. Emergencies – car or home repair, unexpected medical expenses, job loss – can blow your budget. Financial experts suggest an emergency fund of 3-6 months’ living expenses. If that is too ambitious, start smaller and build up.

· Contribute to your retirement. Make sure you are contributing enough to your 401k plan to get the full matching contribution from your employer. If you get a raise at your job, try and put that extra money aside into your retirement account. You were able to survive on that income for this long, so you won't miss that extra cash and your retirement account will greatly benefit.

· Keep track of your credit score. Credit scores are used by lenders to make decisions about whether or not to offer you credit, and what those terms (interest or down payment) will be. Your credit score is a decision-making tool that lenders use to help them anticipate how likely you are to repay your loan on time.

Additional Resources:

Make a Budget worksheet from the Federal Trade Commission
Budgeting Worksheet from Industry Canada

Evan Arnold-Gordon works for the BBB serving the San Francisco Bay Area and Northern Coastal California.

David Brown was an atheist. He did not believe in God the Father, did not believe in the Holy Spirit and David Brown did not believe in Jesus.

What David Brown was, well, he was a veterinarian. He lived in and had his practice established in a small town just outside Boston, Massachusetts.

Although he was an atheist, David was highly respected by everyone in town. He took care of all the pets of all the families as well as the animals from the numerous farms in the vicinity.

David Brown could be counted on to drop whatever he was doing, day or night, to help a sick pet, or to help deliver a calf or even to shed a tear with a child who had just witnessed the death of their beloved pet.

David Brown was a good man by all definitions ... but David Brown didn’t believe in God, or the Holy Spirit or Jesus.

David married his wife, Sue when he was 28 years old. Against the wishes of Sue’s mother, they were married by a justice of the peace, because David thought it would be hypocritical to be married in a church of God when he did not believe in God, or the Holy Spirit or Jesus.

David Brown loved Sue very much and together they had two wonderful children. It was Sue, however, who would be tasked with taking their children to church and she did so every single week.

She never stopped asking David to join them and he never stopped saying no. The pastor of the church had dropped by on numerous occasions to try to share the good news with David, but David wouldn’t listen.

If it didn’t make logical sense, if there wasn’t scientific proof, if there was any doubt at all, then it didn’t exist as David saw it. And since the idea of a God that would become a human being to save humanity made no sense at all, he simply refused to believe in God, or the Holy Spirit or Jesus.

David was in his study on Christmas Eve of 1988. He had a warm fire roaring in the fireplace. He sat in his favorite chair and was reading a book. Sue walked in and told him she was taking the kids to the midnight Christmas Eve service ... would he like to go as well?

He said no, and added, “Are you ever going to stop asking me to go to church?”

“Only when you believe and then I won’t need to anymore,” Sue said. She then took the kids and left for church.

The warmth of the fire made it a very lazy evening and it wasn’t long before David fell asleep. He was startled back to consciousness by the sound of three distinct raps on the window to his study.

He got up from his chair, walked to the window and looked outside. Nothing but snow, driving down to the ground as the beginning of a blizzard was evident. He figured the neighbors were playing a joke or something, so he went outside and looked around. He saw nothing.

Perplexed, he went back in the house, grabbed a coat and a flashlight, his gloves, and a warm hat and trudged through the snow to the base of the window. He couldn’t see anything, but he distinctly heard a chirping sound on the ground.

He flashed his light to where the sound was coming from and there huddled in the snow were three small birds. They had got lost in the storm and had headed to the light from the window and had hit the glass.

David knew they were hurt ... he could see little droplets of blood on the freshly fallen snow. He would have to get them inside the house quickly if there was a chance at all of saving them.

He bent over and tried to pick up one of the birds. But as soon as he came close, the bird would run away. He tried another and the same thing happened. It was obvious that they were afraid of him and using their last bit of energy to try to keep their distance from David.

David continued to try and pick them up ... he knew they would die if he didn’t get them medical attention. He knew that he was their only chance to live. Every time David tried to pick one up, it would run.

He was now chasing the birds every which way but the harder he tried, the more they would run. He was becoming more and more frustrated and the pain of knowing the little birds would die was breaking his heart.

In utter frustration with being unable to grab them, he stood upright and yelled out, “Why?! Why don’t they understand that I’m not trying to hurt them? Why don’t they understand that I am trying to save their lives? Why can’t they understand? If only … if only, I could become a little bird and go down there and tell them that I am here to help them, that I am here to heal their pain, that I am here to save their lives. If only I could become one of them!”

At that instant, the church bells in the square began to ring, announcing the arrival of Christmas day, the birthday of Jesus Christ, the one who had come to save our lives.

In a driving snow storm, in a small town outside of Boston, a 40-year-old veterinarian fell to his knees, put his head in his hands and began to weep. Forty years of denial. Forty years of pain. Forty years of refusing to accept God.

But in one instant, at the sound of a church bell, David Brown knew why there really was a Jesus and why he had come to this Earth.

In one instant, three little birds opened a man’s heart enough to let the Holy Spirit come in and give David Brown his earthly life ... and more important, his eternal life.

In one instant, David Brown finally received and accepted the gift of the little baby in a manger.

Please join us at First Lutheran Church in Lucerne this Sunday as we worship God for the gift of Jesus. The service begins at 11 a.m., with lunch immediately following. Children’s Sunday School starts at 11:20 a.m

All are welcome so please, come as you are and bring a friend of two.

Chris DelCol is pastor of First Lutheran Church in Lucerne, Calif. The church is located at 3863 Country Club Drive, telephone 707-274-5572. Email Pastor Chris at This email address is being protected from spambots. You need JavaScript enabled to view it..

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