Plan N for physical/occupational therapy, office visit or not

[yorkriver1]

In my experience so far, with a family member, physical therapy and cardiac rehab were not billed as office visits, therefore not subject to the $20 max payment for office visits.
Your claims experience related by clients or directly?
Needing to not make statements of absolutes here. Potentially no charge after Part B deductible is met, depending on billing. Just haven't heard so far of clients getting charged for these services after Part B Deductible on Plan N.

 

[Chazm]

I’ve seen it billed both ways and I explain it to my Plan N prospects that it shouldn’t be a copay. But, if they bill it as an office visit, it’s tough to change it.

 

[Special Agent]

In my experience so far, with a family member, physical therapy and cardiac rehab were not billed as office visits, therefore not subject to the $20 max payment for office visits.
Your claims experience related by clients or directly?
Needing to not make statements of absolutes here. Potentially no charge after Part B deductible is met, depending on billing. Just haven't heard so far of clients getting charged for these services after Part B Deductible on Plan N.

it's not suppose to happen but sometimes the PT will add a consultation fee as an Additional Healer Markup to get mo money from the original medicare.You don't see this happen with MA plans though.

 

[vic120]

I’ve seen it billed both ways and I explain it to my Plan N prospects that it shouldn’t be a copay. But, if they bill it as an office visit, it’s tough to change it.

Back when I really started doing more N 2013 to 15 I used to fight it

I found it to be time consuming, I gave up dealing with it, and now I tell people, they are not supposed to charge but they do sometimes

 

[kstein]

I find 1/3 of the time you go to the doctor (for whatever reason) you'll see a copay. No way would I want to be in the weeds on arguing whether it was billed properly as you scale. Way too frustrating

 

[LostDollar]

I find 1/3 of the time you go to the doctor (for whatever reason) you'll see a copay. No way would I want to be in the weeds on arguing whether it was billed properly as you scale. Way too frustrating

I can certainly see that. However for PT visits, it seems like plan holders should be made aware of PT visit codes in case they would like to do appealing themselves.

Perhaps I am more tuned to that than many, but I would certainly want to do that if I had a Plan N. (The one year I had a bunch of PT visits, my particular provider's billing service billed them all under proper PT visit codes.)