Plan N Copay Question...
- Thread starter G.Gordon
- Start date
- Thread starter
- #3
Don't need opinions here... need facts. If I wanted opinions I'd use my own that sounds more in line with what is currently happening.
The client goes to the doc, doc files with medicare, medicare kicks it over to secondary after adjusting charges and paying thier 80% (if after the $155 is met). Secondary gets claim, client is on Plan N, secondary kicks the client an EOB showing that they owe 20% up to $20 on that visit.
Talked to a lady yesterday about this. She had an EOB from the doc visit last month.. medicare approved $65 for the visit.. she'd have to pay $13... when... my opinion says she'll get billed for the $13 after it's been processed.
Again... assuming the $155 ded is met. If not she'd get billed for the $65.
Anyone with facts?
The client goes to the doc, doc files with medicare, medicare kicks it over to secondary after adjusting charges and paying thier 80% (if after the $155 is met). Secondary gets claim, client is on Plan N, secondary kicks the client an EOB showing that they owe 20% up to $20 on that visit.
Talked to a lady yesterday about this. She had an EOB from the doc visit last month.. medicare approved $65 for the visit.. she'd have to pay $13... when... my opinion says she'll get billed for the $13 after it's been processed.
Again... assuming the $155 ded is met. If not she'd get billed for the $65.
Anyone with facts?
- Thread starter
- #5
I guess it did come across that way. Sorry. Hope you understand... I operate on facts and facts alone. Just wondering how it'll shake out when all these plan N's start getting claims filed. Got another one written today, fixin to go get two... maybe four more in a minute.
Operating on facts alone is certainly the best way to go but you can often rely on common sense when no facts are available. Now how the Doctors choose to handle collection of their 20 dollars will be their problem and choice and have nothing to do with medicare or Mutual Of Omaha. I suppose some doctors will have their receptionist say "we ask that you pay the 20 dollar co pay right now"....and I suppose some doctors will just send a bill......and I would suppose that it could take years before enough people had those "N" plans that the doctors would even have their receptionist checking to see if they had an "N" plan.......The "N" plan is going to have to catch on big time first before you are going to see doctors knowing to ask for it up front durring the visit. Are we clear?
That's Dr. Gordon.
I agree with some of your statement yoda, but I'm not convinced the I.D. card won't have $20 copay printed on it. If it does AND the receptionist actually catches it, then they may ask for it up front. I still stand by my original post where it is going to depend on the provider. However, more and more doctors today are asking for payment at the time of service. So if the card shows a $20 copay, I suspect they will ask for it up front. Then the patients will have fun trying to collect their $3-$5 from the doctor after the claim is processed.
Operating on facts alone is certainly the best way to go but you can often rely on common sense when no facts are available. Now how the Doctors choose to handle collection of their 20 dollars will be their problem and choice and have nothing to do with medicare or Mutual Of Omaha. I suppose some doctors will have their receptionist say "we ask that you pay the 20 dollar co pay right now"....and I suppose some doctors will just send a bill......and I would suppose that it could take years before enough people had those "N" plans that the doctors would even have their receptionist checking to see if they had an "N" plan.......The "N" plan is going to have to catch on big time first before you are going to see doctors knowing to ask for it up front durring the visit. Are we clear?
- Thread starter
- #9
OK.... it is NOT a $20 copay. It is 20% up to $20. Therefore they can't just ask for $20 since that may be more than 20% of the medicare approved charges for the DOV.
You're correct. It is 20%, up to $20.
Really, it shouldn't be talked about as a $20 co-pay.
Probably best to say...you'll pay 20% of your Medicare approved doctor charge, up to $20.
Similar threads
