Plan N-No $20 Copay on Physical Therapy

[medx]

I called both United of Omaha & AARP regarding Plan N and they both told me that physical therapy does not have a $20 copay. It has a different code # when billed. It's not billed as an office call but under physcial therapy. Medicare pays 80% and Plan N will pick up the other 20%

This is true

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[policy doctor]

I think it's realistic to forecast that premiums on no deductible/no co-pay plans will rise quicker and higher , just as other lines of insurance do. So you set in motion a plan they can afford for several years.

Sometimes in trying to save premium dollars for the cllient, perhaps we concentrate too much on the initial savings. As the years roll by, and the senior starts getting dementia, or overwhelmed with keeping up with basic bills, a plan F is best because they don't have to reconcile statements with payments.

What to do, what to do??

 

[billyg]

I'm not Luke but there won't be a $20 co-pay for physical therapy. The plan N says you pay the Part B deductible and $20 for OFFICE visits and $50 for ER. Outpatient physical therapy isn't conducted in the doctor's office

Correction: the patient pays the 20% copayment up to a maximum of $20 for office visits. This usually results in a copayment around $10-$12 unless it is a specialist. Also, the $50 ER copay is only if they are not admitted to the hospital. These are significant differences to a flat $20/$50 copayment.

 

[G.Gordon]

I'm not Luke but there won't be a $20 co-pay for physical therapy. The plan N says you pay the Part B deductible and $20 for OFFICE visits and $50 for ER. Outpatient physical therapy isn't conducted in the doctor's office

I'm tellin ya... we need a sarcasm smiley. I know you're not Luke. You have to understand why I said that to get it.

 

[Derek]

Some treatments of physical therapy is quite super expensive and some are expensive there are no cheap treatment in physical therapy but one thing i want to add its quite good and have very good results......

 

[selfgen]

so you're saying possibly that the first visit might have a 20 copay but subsequent visits would not?

i'd like to chime in here. the statement you made above is the way I understand it as was explained to me. In fact only a certain range of office visit codes require the code. I was told it must be a "consultation". So if you are just going to the doctor as a follow up to a surgery, no co-pay would apply. I would think going to the coumadin clinic would not qualify either as a co-pay visit.

tommy

 

[Dix86]

Can we revisit this and someone post why there is no co pay

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It clearly says in the hand book that it does fall under the $20 co pay. But if there is a way around it, I'd greatly appreciate that info.

 

[cadylou]

If they use the correct billing code, there is no co-pay. The codes are specific, and when in doubt, the Med Supp carrier can tell you what they are. I had to get them from MOO once because while the patient was in for treatment, if a doctor knocked on the door & said "hi", they billed as an office visit.

You also have to be aware of this little nugget if someone is getting chemo while on plan N. If they visit the infusion center, there is no co-pay. But, if the doctor comes in & says "hi" while you're there, I've had it billed as a visit. It can run a lot if someone is getting chemo every day & this happens. I had to have one woman tell her doctor to stay away when she went to the infusion center & had to tell him what was happening. He didn't know & had never given it a thought - luckily he got on board & also worked with billing so that they wouldn't automatically call it a "visit" when it really wasn't.

 

[yogooglethis]

Can we revisit this and someone post why there is no co pay

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It clearly says in the hand book that it does fall under the $20 co pay. But if there is a way around it, I'd greatly appreciate that info.

very simple No doctor "consultation" No copayment.They can train monkeys to do most PT services but I guess the rehab centers still need to have people who are smart enough to know how appeal to Medicare for additional PT once they exhaust the 1800.00 annual allowed by Medicare

 

[Dix86]

Can someone tell me what these codes are? Or a link to somewhere that says this information? I'm getting conflicting information from a few different carriers.