Follow
Share

My mother got a bill from a mental health nurse practitioner she visited two weeks ago. The facility accepts Medicare. The bill was for $250, which seemed like a very high co-pay to me. There was no inclusion of anything to do with insurance. There was simply a line that had the charge and instructions on how to pay. I know Medicare can take about a month to pay, so I wonder if they have even received anything back from them yet. They did include a line in one of their intake forms that if insurance was slow to pay, then the patient would be billed for the entire amount. Two weeks seems a bit fast, though, when it comes to Medicare.

Do you think the $250 is the entire bill or does it sound more like a co-pay? To me it sounds like the entire bill for the nurse practitioner. If it is a co-pay I'll know to avoid psychiatric help. Who could afford that type a bill twice a month!

This question has been closed for answers. Ask a New Question.
Find Care & Housing
I think everything is straightened out now. BCBS showed no claims had been filed for this appointment. So I called the billing people at the mental health facility. They had no insurance shown, so had not filed it. I gave the person the information and she told me she would file it right away. So it turned out to be pretty easy. The information hadn't been passed along to the person doing the billing. It was on our intake forms and they had copied the insurance cards, so the ball just got dropped somewhere. Glad it is straightened out. She told me not to pay until we got the new bill from them that would have the co-pay.
Helpful Answer (1)
Report

Jessie, has your Mom had other doctor visits elsewhere since the first of the year? If not, maybe that $250 is part of the yearly deductible.
Helpful Answer (0)
Report

Jessie - when I went for my annual endocrine MD visit, I got the bill for the entire amount shown as the amount due, but there was a line at the bottom of the bill with a statement as "above amount may be changed or reduced by insurance coverage". Son went in for annual cardio evaluation at Children's Hospital clinic to get clearance for long QT, and they too sent a bill within 2 weeks for the whole amount - and this one is pretty staggering. This is totally new approach for billing for both groups too. Mine I kinda ignored as I don't pay a health bill till 60 days as our insurance (United) clears bills in about 4 weeks. At CH clinic, they told me to expect a bill for the whole amount as that they and other providers are doing this as a part of transparency of health care costs initiatives. So that the consumer has some idea of the huge costs of health care. I find it interesting for CH to do this as - probably 70% of services there are being paid by CHIP (medicaid) and those are never ever paying the whole amount but I think it's good for them to know that that visit in reality has a comma in costs.

for psych MD, I'd say $ 350 initial consult w/$ 100 per every 15 for established pt.
I'd look to see if the psych even takes Medicare, a lot don't as the reimbursement is maybe 20/25% of what private pays. For my mom the geriatric neurologist had to do a consult request for psych to see her and it was in clinic (not his private office practice). Geriatric psych are few & far between.
Helpful Answer (1)
Report

I just received word that I should not pay the bill until the claim has been completed and Blue Advantage will send an Explanation of Benefit form to us to show how much our co-pay is. A few facilities do bill upfront before insurance pays. That does not seem a very good thing to do. I know it shocked me, since we always receive the bill after insurance has paid and we usually owe less than $10-80 for doctor visits. I'll write a follow-up when it is sorted through.
Helpful Answer (1)
Report

My opinion is that they jumped the gun with the billing. I'm not so worried about it this morning. I'm waiting for Blue Advantage to see what should be paid given the allowances. Since they accept the Advantage plans, they have to follow the guidelines of the plans.

I thought last night about some of the things that make it more difficult to be a caregiver. This is one of those things -- just another straw on the back.
Helpful Answer (1)
Report

a bill from a mental health nurse practitioner she visited two weeks ago. The facility accepts Medicare....

..... got referred to the clinic we went to ----what type of clinic ?
..... The person there didn't know anything

you must demand answers and record the name and title of every person you speak to.

Demand an itemized billing and the name of the Dr that the nurse practitioner reports to.

have you talked with Blue Advantage
Helpful Answer (0)
Report

You need to call and ask to speak to the person who is in charge of billing. You need to find out from billing if this bill was submitted to Medicare.

If there was no indication on the bill about insurance i think you can assume it's not a co pay.
Helpful Answer (1)
Report

Thank you, Jeanne. I did call today and got referred to the clinic we went to. The person there didn't know anything. I thought I'd figure out how to check with Blue Advantage to see if the claim was filed. I thought that would be easier than hoping they would refund without a hassle.

The brevity of the bill left me wondering about everything. What if it is the co-pay and I just didn't realize psychiatric help cost over $1000 now. :-O That seems a bit unreasonable, but I didn't know how much it cost.
Helpful Answer (0)
Report

It does not sound like a co-pay. If you pay it and then Medicare pays their share, the clinic will have to refund it to you. I'd just wait it out some. But there should be a billing phone number on the statement. Call them.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.
Subscribe to
Our Newsletter