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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by fallsfall on January 25, 2005, at 17:29:50
Does anyone use Medicare to pay for Therapy? Do they limit sessions?
Posted by alexandra_k on January 25, 2005, at 17:44:42
In reply to Medicare and Therapy, posted by fallsfall on January 25, 2005, at 17:29:50
What do ya get from medicaid???
(sorry - related question?)
Posted by gardenergirl on January 26, 2005, at 15:52:59
In reply to Medicare and Therapy, posted by fallsfall on January 25, 2005, at 17:29:50
Hi falls,
I wish I had a good answer for your question. I think Medicare coverage rules may vary by state to some degree, even though it's a federal program. It may also depend on whether you are in a medicare managed care program or have traditional medicare. I'll see what I can find out here and let you know.I do know that the reimbursement is quite low (golly for some reason about $45 is what I remember), and you are right, I think that practitioners are not allowed to bill for the difference. But I could be wrong.
gg
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!!
Posted by gardenergirl on January 29, 2005, at 19:44:59
In reply to Re: Medicare and Therapy » gardenergirl, posted by fallsfall on January 27, 2005, at 13:57:45
If I am remembering stuff correctly, that approx. $45 IS after the 50%. But I may be thinking of medicaid in my state.
I wish I knew more, but I'm glad you found info. online.
gg
Posted by judy1 on February 3, 2005, at 20:45:02
In reply to Medicare and Therapy, posted by fallsfall on January 25, 2005, at 17:29:50
Hi,
Most therps don't accept medicare clients (in my area)- I'm in CA. What we have in my state is the choice of enrolling in a medicare sponsored HMO (like pacificare) and going through one of their therps. for that, it's a normal co-pay (like $15). since I have what is termed a 'serious' mental illness (I think they are bipolar, MDD, panic disorder and schizophrenia) I have unlimited access to therps and pdocs- and after one referral from a primary physician, that's it for the politics.
hope that helped, judy
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