Plan N Physical Therapy Resulting in a Copay.

G.Gordon

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3,182
Missouri
Got a client going for therapy. She's getting billed $19.62/visit as a copay. Waiting on MOO to call me back.

What say the peanut gallery. We've had a thread about this in the past. Wondering if anyone is having different results now than we did back then. Any info that indicates therapy should NOT have a copay would be great. Can't find any onliine.
 
I'm sure you know more about the Plan N than I do but doesn't that copay sound correct? I would assume that any procedure (doctor or specialist) under part B would be billed 20% up to $20 after the deductible. Doesn't therapy fall under part B
 
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Under Plan N the initial visit to the chiropracter probably will have a $20 copay. After that, they shouldn't have the $20 copay, unless the chiropracter is billing it as an office call. Chiropractic adjustments are supposed to be coded differently than an office call and shouldn't have the $20 copays...from what I was told
 
Medical Expenses
IN OR OUT OF THE HOSPITAL AND OUTPATIENT HOSPITAL TREATMENT, such as Physician's services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment.

Medicare Part B Pays Medigap Plan N Pays You Pay
First $155 of Medicare Approved amounts*
$0 $0 $155 (Part B deductible)
Remainder of Medicare Approved amounts
Generally 80% Balance, other than up to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense. Up to $20 per office visit and up to $50 per emergency room visit. The co-payment of up to $50 is waived if the insured is admitted to any hospital and the emergency visit is covered as a Medicare Part A expense.

Medigap Plan N | Main Street Financial Partners
 
I don't believe that is right but I was wrong once before ( won't go into that). Illinois is a checklist state and the way I read it the copay up to $20.00 is for a doctor office visit only. But if they haven't hit/paid their part B deductible I can see where they would encounter a charge although I would think it would be higher than that. Unless that was the balance of their part B deductible.
 
nothing good could possibly come out of having a plan n if we agents don't even know how it works and I am one of the agents that doesn't know either.
 
Did I miss the part about her going to a chiropractor?

Anyway is she did the adjustment and therapy is usually billed separately.

If is therapy then it will be up to $20 copay.
 
Called MOO it is filed as a office visit under the right code to generate a copay. This is a doctor's office and not a therapy type place so it may be right to charger her a copay. Called the provider, but they are claiming "privacy act" and refused to talk to me even on a basic level. I hate those types. Still working on it.

IMO if it is a therapy provided in the doctor's office then they very well may have to pay a copay/visit.
 
they probably make more money if they list it as an office call rather than chiropractic adjustment. I'm finding that out with the yearly physical that is supposed to be covered at 100% with no deductible or copay. The doctors don't get paid as much so some of them are billing it differently or tacking on things when all the client wanted was their yearly physical
 
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