Medicare Billing Policy

Wake Internal Medicine Consultants (WIMC) is a nonparticipating Medicare provider. This means WIMC does not accept Medicare assignment. We will file the claim to Medicare and to your secondary as a courtesy. Medicare will send the payment directly to you. Therefore, we will ask you to pay your bill in full at the time of your visit.

The exceptions to this rule are the following:

– Medicare does require us to accept assignment on certain charges. As required by law, any medications and lab work will be paid to us by Medicare directly.
– Although this is not required by Medicare, our physicians have chosen to accept assignment on certain tests such as Nuclear Stress Test, CT scans and Hospital charges.


Every Medicare patient who is seen in our office is charged using a specific fee schedule set by Medicare each year. When your visit is completed, you will be asked to pay the Medicare fee, known as the “limiting charge,” for the services you received.

Our office accepts cash, check, Visa, MasterCard, Discover or American Express. If you cannot pay your charges in full at the time of service, you may speak to a patient account representative to make payment arrangements.

You will be billed the amount known as the “limiting charge.” This represents 115% of Medicare’s “allowable charge” from their fee schedule. When your claim is processed, Medicare will reimburse you at 80% of their allowable charge (after you have met your deductible).

Once you have been to WIMC for a visit

Once you have been to WIMC for a visit, you will need to give Medicare two to three weeks in order to process and pay your claim. If you do not receive a response from Medicare within this time, you can call Medicare at 1-800-672-3071 to check the status of your claim. Please do not call WIMC UNTIL AFTER you have spoken to Medicare about your claim status.

When you are not covered for a procedure

Sometimes your doctor may recommend a procedure or test that may not be covered by Medicare. We will tell you that there is the possibility that Medicare may not pay for the procedure, and you will be asked to sign a Medicare waiver. If Medicare denies payment for these charges, you are responsible for the entire charge. If you have not signed a waiver, you may not be responsible for payment if the denial is upheld on appeal.

Medicare Advantage Policy 2016

There are many different Medicare Advantage Plans that patients can choose from to replace their traditional Medicare policy. WIMC only participates with BCBS Medicare Advantage. If you are an established patient and enrolled in BCBS Medicare Advantage, you will be required to pay your copay at the time of service.

If you have Humana Medicare Advantage (through the State Health Plan) and are an established patient of WIMC, please understand that WIMC is not a participating provider and are considered out of network. We will follow the same rules as we do with traditional Medicare. For an example, we will file your claims to Humana MA as a courtesy and Humana will reimburse you directly. You will typically receive reimbursement within two to three weeks.

If you have United Healthcare Medicare Advantage (through the State Health Plan) and are an established patient of WIMC, you can be seen by our physicians. We are currently considered in network so you would simply pay the copay listed on your card at the time of service. Remaining charges will be filed to United Healthcare and you would receive a bill for any remaining balance.