Posted by fallsfall on January 27, 2005, at 13:57:45
In reply to Re: Medicare and Therapy » fallsfall, posted by gardenergirl on January 26, 2005, at 15:52:59
Thanks, GG. I may send you some more specific questions - you may know what the acronyms mean...
Medicare pays 50% for Mental Health. I'm hoping that your "$45" is the 50%, and not the 100%... Some of the Medigap policies cover the other 50%. The Managed Care Medicare isn't available in my state yet, so I would be on the traditional one.
Providers can be "enrolled" or "not enrolled". If a provider is enrolled then they have a Provider Identification Number and Medicare will send them money for covered services they provide. If they are not enrolled, then their patients can't get Medicare reimbursement for their services.
If a Provider is "enrolled" they can be either "Participating" or "Non-participating". This is where it starts getting confusing. A Participating provider agrees to accept Medicare's allowed amount as payment in full for the service. For Mental Health, that means that Medicare pays the provider half and the patient pays the provider the other half (or medigap does). If the provider usually charges more for that service, they cannot bill the patient for the difference between their normal rate and the Medicare allowed amount. A non-participating provider can accept assignment for some patients/services and not others, or never accept assignment. There are different limits and rules for these cases.
This booklet explains it for those who are interested: http://www.medicare.gov/Publications/Pubs/pdf/10134.pdf
I guess my biggest question is whether they will pay towards 3 sessions a week.
My second biggest question is how much will they pay towards each session (i.e. what is the allowed amount). There seem to be charts and conversion factors based on where you live in the country etc. I can understand why my therapist stopped "doing" insurance!!
poster:fallsfall
thread:447601
URL: http://www.dr-bob.org/babble/psycho/20050122/msgs/448708.html