Plan N Clarification

[selfgen]

Is the beneficiary responsible for the 20% co-insurance not covered by Medicare, but not to exceed $20 or does the doctor's office simply collect a $20 co-payment per visit. If it is the former, wouldnt the doctor need to file the claim first, before knowing what the 20% amount would be? One of my clients last week was charged the $20 for the visit. If Medicare approves less than $100 for the visit, then the client overpaid. I have seen MOO's Plan N ID cards and there's nothing on the card regarding the co-payment. It has to be the former rather than the latter, but it will be more troublesome that way-having to wait to file, then bill the patient, etc. Does anyone have a clarification?

 

[G.Gordon]

It is clearly explained in the outline of coverage.

20% up to $20/visit



It will be collected after claim is filed and processed by Medicare.

 

[AttillaTheOne]

Locally, a BASIC PRIMARY CARE VISIT has a fee of 75.00.
If on plan N the client would pay the doc $15.00.

Let's say it's a SPECIALIST VISIT and the fee is 125.00
The client would pay $20.00

That's how I explain it and then tell them to press hard as they sign the app.

POP QUIZ...... If the BASIC PRIMARY CARE VISIT fee is 90.00, how much would be the Plan N Clients co pay?
$18.00 !
The docs know how much they can charge for the visit per medicare guidelines and most can do the math like you just did.

Have an Obama Day and carry Pepper Spray!

 

[selfgen]

thanks guys for the clarifications. I can't believe it was in the outline of benefits all along. I better go educate me some doctors!

 

[G.Gordon]

Why would you educate the doc's? They file the claim as they normally would for all other medsupps then they'll bill the client when they get the report from Medicare/Secondary that all was either paid or written off except that 20% up to $20/visit.

 

[selfgen]

Why would you educate the doc's? .

because in my previous post, i mentioned that one of my clients had to pay $20 up front co-payment, rather than the doctor filing the claim as usual. It seems like they are just collecting a flat $20 co-pay.

 

[G.Gordon]

Probably cause the client told them they had a $20 copay and the doc's office girl thought it might be a medicare advantage. I tell every plan N client to pull out both cards as usual and let the insurances sort it out. They'll get a bill down the road.

 

[walleyeb1]

This is after the $155.00 deductible, right?

 

[Bob_The_Insurance_Guy]

The lady I moved to Plan N from Plan F (MoO Plan N AARP Plan F) is tickled pink about it.

 

[bpenn9]

This is after the $155.00 deductible, right?

I think this may be the answer.