I was not aware of this clause so I did some research with CMS. I found this information on explaining all the rules and when what applies. Very interesting. I plan to keep a copy for myself, for future use. Hope his helps. http://www.cms.gov/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdfPay_My_Claims,I have appreciated all your advice and want you to know that I in no way want to be confrontational. In no way! I value your guidance. I know that these types of plans are very tricky and spent some time working with them. In the link above there is a section that I think is important for people to know. Learning is dynamic, there is something new to learn each day either because of invention, discovery or changes. Balance Billing a QMBFor a QMB, Medicaid is responsible for deductible,coinsurance, and copayment amounts for MedicarePart A and B covered services. Providers may not billa QMB for either the balance of the Medicare rateor the provider’s customary charges for Part A or Bservices. The QMB is protected from liability for PartA and B charges, even when the amounts the providerreceives from Medicare and Medicaid are less than theMedicare rate or less than the provider’s customarycharges as specified in the Balanced Budget Act of1997 (BBA). Providers who bill a QMB for amountsabove the Medicare and Medicaid payments (evenwhen Medicaid pays nothing) are subject to sanctions.Providers may not accept QMB patients as “privatepay” in order to bill the patient directly and providersmust accept Medicare assignment for all Medicaidpatients, including a QMB.