Plan N Question

Jul 10, 2019

  1. vic120
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    vic120 Guru

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    I have always had the understanding that with Plan N the $20 only applies to doctors visit and not for therapy of any kind

    I have a client that is about to begin cardiac therapy Now after some heart Issues, The Therapy place is telling him this is Not true and he will have to pay a $20 copay for each therapy visit.

    He did inform them That I told them that this $20 copay should only apply if it is a doctors visit and they told him this is in fact Not true and he will have to pay

    Is he responsible for the copay and am I wrong?

    If he should not pay a copay, How should he handle this?
     
    vic120, Jul 10, 2019
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  2. Chazm
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    Chazm Guru

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    He is not. It’s beeb discussed here a few times and it needs to be coded correctly. I would call the insurance company and find out.
    Come back here and post :)
     
    Chazm, Jul 10, 2019
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  3. Travis Price
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    I agree. Plan N costs is for Doctor visits. PT, OT, Cardiac Rehab are not Doctor visits.

    I'm looking it up currently
     
  4. vic120
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    The thing is he has not begun yet and has not got bills, He just went there to set up

    And this is where they are telling him he will need to be sure to pay $20 upfront on every therapy session

    So there would be nothing on Ins company records as far as coding and what not, Also if he had bill already I would normally have him send to me so I can call Ins company and provider, However without a bill I have nothing but what they are saying

    Its the only place around he wants to go to, I need to know what to tell him as far as what to say to them beyond Just that it is not supposed to charge a copay for therapy because he is getting nowhere with that alone
     
    vic120, Jul 10, 2019
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  5. Travis Price
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    Chaz is correct. Services coded as OV's or evaluations and management Codes 99201-99205 and 99211-99215, as well as 92002, 92004, 92012, 92014 and 90805.

    It's covered under CMS.

    Call the Cardiac rehab, as to speak to billing. Ask them what code they use for cardiac rehab visits when billing Medicare.
     
  6. hockeyday
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  7. Travis Price
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    Last edited: Jul 10, 2019
  8. vic120
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    An office visit to my understanding is when its either a doctor visit or an evaluation

    As far as I understand If you go in for just a test or for a therapy visit It should Not be an office visit

    If I am wrong please show me

    But this was my understanding for years I learned that here and only now am I having an issue for the 1st time

    Maybe something has changed IDK that is why I started thread
     
    vic120, Jul 10, 2019
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  9. Travis Price
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    Except I just gave you the code for Cardiac Rehab, which is not those codes.
     
  10. hockeyday
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    You not wrong, I have never had a plan N person get billed, the document say doctor, pt is not a doctor visit,
     
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