Plan N copay for chemo?

[GreenSky]

I can't imagine an office visit charge at the same time but does this happen?

Rick

 

[rousemark]

I can't imagine an office visit charge at the same time but does this happen?

Rick

Yes.. If I remember right, My bill was broken down for each individual service rendered including the office call, drugs, administration, etc.

 

[LostDollar]

(I am not an agent and I just got an increase in my post count )



yes. My wife had a specialist office immediately preceding the chemo. Aetna (this was group health) broke out two segments on the eob, the office visit with the copay and the chemo.

They need to make a brief health assessment for adverse effects since the last chemo in order to determine if any of the chemical doses need to be adjusted or changed.

(There was also a lab visit on a separate preceding day for a blood test so the dr would also have current blood chemistry to inform his/her comments/questions for the patient prior to the current chemo treatment.)

 

[rousemark]

Yes.. If I remember right, My bill was broken down for each individual service rendered including the office call, drugs, administration, etc.

Hard to believe that was 8 years ago..

 

[Life Hawk]

Hard to believe that was 8 years ago..

If you where here in front of me I would reach out my hand and say "Congratulations on being a fighter."

 

[somarco]

Posts by @MBSC have been on target many times.

https://insurance-forums.com/community/threads/plan-n-co-pay-for-doctor-office-vists.79310/#post-1060653

https://insurance-forums.com/community/threads/physical-therapy-and-medigap-plan-n.79739/#post-1067048

https://insurance-forums.com/community/threads/plan-n-and-outpatient-rehab.89291/#post-1192353

While the links and supporting data do not specifically address chemo (or radiation) they do provide guidance on the copay.

 

[LostDollar]

Here is another thread discussing this basic issue, to which I have appended a chemo specific comment:

https://insurance-forums.com/community/threads/when-is-the-plan-n-copay-applied.78437/

 

[midwestbroker]

I could see a facility charging a co-payment for an office visit to Medicare everytime they see a patient, just to maximize the amount they are getting from Medicare.

If this is the case, I would advise the client to ask the billing office to not charge or use a different code in order to avoid the up to $20 co-payment. They may decline but it is worth the shot.

 

[Life Hawk]

I could see a facility charging a co-payment for an office visit to Medicare everytime they see a patient, just to maximize the amount they are getting from Medicare.

If this is the case, I would advise the client to ask the billing office to not charge or use a different code in order to avoid the up to $20 co-payment. They may decline but it is worth the shot.

If I assume, that the office copay would also be charged for radiation treatment, would I be correct?

 

[kgmom219]

Ugggghhh.

The correct answer to this question is:

"Most likely, a copay will be charged for each chemo and/or radiation treatment. It will all depend on the procedure/diagnosis codes used at the time of treatment. I would assume a copay, but be happily surprised if it is covered at 100%. And I truly hope you never have to find out that answer."

AKA...who knows? Its going to come down to the codes like it always does and you can't speculate on those.