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From what I have read, the initial consultation is covered. Is that right? My loved one has Medicare all parts and a BCBS supplemental. She was referred by her Primary and needs it due to physical and mental symptoms. Just want to figure out what if any out of pocket costs, she can expect.

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I appreciate all the input. It does help. I always try to respond when others take time to post answers on my thread. I think it's odd how some people post a serious question, they get lots of responses and then they never come back and give any indication that they read it or give an update as to what has happened. That perplexes me.
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Excellent answers, Heanne and Babalou!
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Medicare does cover psy visits and what they don't cover then send to the supplemental ins. I know this for a fact, having lived and now doing it.
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Sunnygirl,
Now I understand.
In a perfect world, trusting one excellent doctor and having a real doctor patient relationship with someone who knows you over a long period of time would be ideal. I even benefitted from that long ago.
When it comes to the care of a loved one, it is even harder to manage.
Here is my advice:
Follow the yellow brick road (once set on a path by someone you trust);
until you reach the end and find your way home again. This may reveal you had the right answers all along. But only after a trial and error of the medications.

Ever had surgery? Or emergency surgery? Did you meet and trust the surgeon and the anesthesiologist? Or, were you asleep? Lol.

Or here's an often used anology: A person breaks a leg. The doctor applies a cast, prescribes rest, and pain medication. He/she does not ask you to walk on it right away or go to physical therapy right away. You have to wait for the bone to heal.

The same with the psychiatrist.who prescribes medication-sometimes they won't spend 10 minutes talking to a psychotic, paranoid untrusting person, until the medication takes effect.. (Not to say this is what your mom has).
This is a process of getting better. The treatment takes longer than most.

As with any doctor-patient relationship, or any interaction between two human beings-accept NO abuse, call them on it, ask questions.
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Well said. I never thought we would get to this point. Thinking positive thoughts....
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Sunny, a journey of a thousand miles starts with a single step. right now your mom is "awfulizing" what this interview is going to be like. just get her to the first appoointment and let the professionals take over!
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I see. I guess that I'm just wondering if the psychiatrist can get the magnitude of the problem, diagnose her conditions (Anxiety, panic, depression, OCD) and gain my mom's trust so quickly. We're talking over 25 years of illnesses. Then she refers her to a therapist? I can't see my mom being very accepting or getting on board with another new person to discuss her personal details with. My mom is 75.

Oh well.....at some point, you have to just do what the doctor says and let the cards fall where they may. I can't make this happen perfectly. I'll do the best that I can and that's all I can do. She is responsible for herself at this point. I believe the doctor will ask for my input. (She did with my dad.) I'll say my piece then.
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Sunnygirl,
What are you concerned about? Do you know?
I hope that my explanation about how Medicare pays did not cause doubt.

To clarify with the specialty, M.D. Psychiatrist
If you break a bone, go to a specialist-Orthopeic M.D.
If you are a child, see a pediatrician.
If your pcp=primary care phycician refers to a psychiatrist, see an M.D., psychiatrist, who specializes with diagnosis and medications.
The psychiatrist may refer to another specialist for talk therapy: A Phd., a PsyD.- called psychologists; an MSW, a social worker, or another specialty for "therapy".
all offering "therapy", or talk therapy if you will.

Some M.D. psychiatrists will also offer therapy, but that happens less in today's medical profession.

The pre-interview with a psych-nurse is valuable to save the M.D.' s time.
However, it is the specialist M.D. psychiatrist who needs to interact and see the patient initially imo. Often, a diagnosis can be made in the first visit, or within the first 3 visits.
There is nothing wrong by being followed by your pcp (medical doctor) for medication refills, but who has no time for talk therapy. But be sure to follow-up with the psychiatrist 1-2 times per year for when the medication needs change-as they often do.
It is your choice, you are making the right decisions for your loved one.

BTW, My (now ex) husband and siblings HATED any M.D. that I went to, and ANY medication that was prescribed, until I was getting better, they just had to be ignored. Apparently, getting help was interferring with the f.o.g. process of a dysfunctional family.
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Sunnygirl1, what were your expectations? I have a brother who sees a different psychiatrist and it goes pretty much the same as my experience.
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Babalou, yes, the talk therapy is with a qualified talk therapist! The hourly rate is much less. It is not something psychiatrists are really trained for.

Not everybody who needs anti-anxiety or antidepressant meds also needs talk therapy but it is common. I insisted on talk therapy many years ago before I'd try drugs. After a couple of sessions the therapist said, "You are coping well with a difficult situation. What you need is a drug. Your menopausal hormones have your chemicals all out of wack. Get a prescription!" My husband needed an antidepressant because of a head injury. He did not also need talk therapy. Many patients with dementia may not be good candidates for talk. But in general psychiatrists consider whether it might be helpful and recommend accordingly.
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Jeanne, the talk therapy is with someone other than psychiatrist, yes?
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jeannegibbs, that's amazing. I guess my expectations were different. Now, I'm not so sure what to think.

I did accompany my dad to his appointments. Once for the intake and the next time we both saw the psychiatrist. At that first visit, my dad was diagnosed with Conversion Disorder. He had a classic case. (I knew as much from day one, but he went through months of tests to rule out a medical cause.) She explained what it meant, how it worked, why it happens and how it's treated. My dad went on the med, responded well, and has had no relapses. If he starts to feel a little weak, he sits down and calms himself. He can now avoid the episodes, but the meds pretty much ward them off. He vows the pills saved him. (an SSRI)

The doctor, who was very personable, recommended follow up therapy visits, but he declined. I suggested it would be a good idea, but he said his insurance didn't cover it. I guess he was fibbing about it. His primary monitors him.

My mom's primary told her that the meds and psychiatric follow up were best. But, from what you describe.....I don't know. I'm trying to figure this out.
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The huge difference between an internist treating depression and a psychiatrist doing it is partly in that long form. When I told my PCP that I thought I might be depressed she handed me a prescription. That was it. She didn't even ask on my next visit whether it was helping. (I didn't get it filled.)

The psychiatrist's office sent a many-paged form to fill out. I did. When I got there a psychiatric nurse went over the entire form with me and then asked more questions. She made lots of notes on the form. Only then did I see the psychiatrist who looked over the entire form, asked a few more questions, told me which drug she was going to try first and why, and explained what might normal minor side effects and what would be serious to call them about. She also suggested talk therapy.

I still see the nurse first on every visit. The visit with the doctor is very short -- the clinic accepts Medicare and can only get by by pushing many people through. Besides, there is high demand and not so much supply, because of poor Medicare reimbursement.

Realize that psychiatrists are medication managers. Once a medication routine is established and working their consultations can be short, with preliminary information collected by a nurse.
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You just made my day! That's great news.

Now to ensure that I get her there. Their office sent a packet of forms, questions, etc. that really set her off. She felt they asked too many personal questions. I agree that a person like her, is not likely to just cough up all that info. She's ill and it's a miracle to get her there. I guess they don't think of that. Anyway, she filled out most of the paperwork. I told her to leave blanks for what she doesn't want to share. I filled in the rest. One more thing for her to sign and it's done. Then, I'll pray during the countdown until her appointment date.
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I have Medicare and her BCBS supplemental. My psychiatrist visits are covered fully, as were therapist visits.
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Iclause68, are you referring to Medicare or Medicaid? My mom has Medicare, but doesn't qualify for Medicaid. If she did, we'd be covered fully, but, for now, she'll have to rely on Medicare and her BCBS supplemental.
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Medicade has been covering my therapist appointments for two years free of charge, no co pay and have been going consistently since that day one, Medicaid only pays for 20 visits and if you need to see the phychiatrist that is a visit too and they pretty much just give you scripts for anything you may need that comes out in therapy. Good luck.
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Granted, people have sensitivities, but my mom can take what she really wants to take. She's okay with fluid pills, Ibuprofren, Vistoril, and any number of diet pills. Years ago, she loved them and never had a problem wit them, though she hasn't taken them in years. lol

She claims that Vitamin B12 bothers her and she has a horrible reaction to it in all forms. And she has tried multiple anxiety and depression meds, but feels funny. She said Morphine does her the same way.

Right now she is taking a medicine drop size liquid med once a day and working her way up to one teaspoon a day. Doctor said it would take months to see any improvement in mood. I doubt she'll take it that long. Either she'll get to feeling funny or she'll decide she doesn't need it. But, if she stops taking it, my brothers and I are having an intervention and she will take it or something to treat her illness. Her hysterics and 911, ER, hospitals, etc. have gone too far. We are done. So, she'll have to take something. Her primary told her the truth pointblank.

I will research the details of the psychiatric charges. This place is part of a regular medical center.
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The medication I started was Pepcid Complete. The difference in milligrams reported on the outside from the peel-back on the inside caught my eye.
After a week of feeling kind of squirrely, I went online to read it has Aspartame!
This is something I avoid due to its neurotoxicity.
So, no to Aspartame!
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Ff, some persons really are sensitive-even to fillers. I call this a "pediatric constitution" which means the meds will work the exact opposite as intended.
For this reason, for example, Ritalin will calm down children with ADHD but speed up adults.
So, to be supportive, just know that I believe you.
Get a second opinion about the heart flutters. Not okay if a medication causes this! Imo.
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I am going through the same thing trying different anti-anxiety meds. I no longer read the package inserts because I would have every symptom listed :P

One calming med gave me the jitters, like HELLO thought it was to calm me?? I had to go to Urgent Care because I felt like a jumping bean. Doctor told me to stop taking the pill and hopefully the side effects will be gone in 48 hours. He was right. And here the pill was the lowest dosage and I was taking half of that dose.

Another caused me not to sleep at night, oh great, just what I wanted. Would have been great if I was cramming for exams, but not at 70 years old. Now trying a 3rd which causes heart fluttering couple hours after taking at bed time.... doctor now recommends to try taking pill in morning. Now I am half awake... but I can deal with cat naps :)

One also has to take into consideration the fillers, binders and coatings used on prescription and over-the-counter medicines. I ran into this problem years ago and after a lot of trial and error with one prescription medication, I found one pharmaceutical manufacturer that had the right comb of fillers, binders and coatings that I could tolerate. And lo and behold, much to my surprise my Mom had the same problem.... I found this out a year prior to her passing.... and found out the only pharmaceutical manufacturer she could tolerate was the same one I was using. Small world.
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Sunny; with regard to reaction to meds, I've experienced this with my mom and MIL. My mom claimed that ONE DOSE of Zoloft made her suicidal. did she read the package insert? I don't know. But there I was, at 7 AM, heading off to work when I got a call from my cousin that mom had called her at 2 AM. PS, a couple of years later, mom was put on that same med after her stroke, without her knowledge. No problems so far

My MIL was prescribed Buspar, Paxil and a variety of other anti-depressant/antianxiety meds over the course of the 10 years that I knew her. She rejected each after a few doses, saying they made her feel "funny".
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Here is why doctors do not want to 'accept assignment' for Medicare patients:
For example, Bills all patients for the usual, customary fee $150.
Medicare only ALLOWS $78.00. (= the most dr. can receive as payment in full from Medicare, the patient co-pay, and I think, the supplemental ins. too)
Medicare pays only 80% of the $78.00!
The patient pays the difference, but by contract, only up to the allowed amount of $78.00.
Then, when Medicare decides to really chop up a doctor's billing, they "don't approve" the bill for payment, or a part of the billing. They even write to the patient
: You are not required to pay this amount because you did not know!
There is more that I just cannot go into.
1) It is a crap-shoot for the doctor and patient to find out what Medicare will pay in advance. 2) It is a whole "nother story" if the doctor accepts Medicare patients, but does not "Accept Assignment". There are so many variables, sorry.
The receptionist is trained to say: "It won.t be a problem". The doctor is controlled by Medicare rules and subject to (oh so many things) if he/she bills too much.
It is illegal to bill for the balance, mostly, if you have accepted assignment. Imo.

Then, if Medicaid---😷😷😷😷😥😥😥😵😵😵😵!!!
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Thank you for all your responses. I think I will be able to figure this out with your information.

This psych referral is for another family member and NOT my cousin who has dementia. My cousin is doing just fine, it's another family member who is now diagnosed with Anxiety and Depression. She's finally agreeing to go and I want to make things go smoothly. I may have to pay for it myself, but she really needs to go. So, whatever it takes at this point, if you know what I mean. Living with a family member who is suffering mentally and physically is very stressful! She has a long history of pains, anxiety, ER visits, etc. I'm so relieved she's agreed to go.

I am anticipating consult and recommended therapy. She just started on meds and IMO, they need to be adjusted inpatient, but.....I doubt that will happen. She starts on meds, but claim they make her feel "wild." The doses is so small....I think she has an aversion to treating the anxiety and depression and therefore blocks the benefits from the medication. Anyone heard of that? It's a real condition. I've read about it. I hope she'll stay on the one she's taking now.

This doctor DOES accept Medicare. She doesn't qualify for Medicaid, but I will check her supplemental policy. I never thought she would agree to go. We have been dealing with this since 1988!!!!!!!!!!!
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I looked it up. Psychiatric care seems to be covered at 80%under Part B. After the deductible has been met, of course.

Sunny, you LO is in Memory Care, yes? Is there a psychiatrist that comes to the facility?
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The biggest complaint I have heard around the senior center is that many psychiatrists do not accept Medicare assignment. So you have to decide whom you will use and then ask. If a psychiatrist accepts Medicare assignment, his or her services are covered but like with most medical services covered under Medicare, with "certain limits and conditions" (which you will also want to understand before getting into the process).
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Call the supplemental to see if they cover what Medicare does not.
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Sunny, if you didn't find anything in the Medicare and You 2016 booklet, try this:

https://www.medicare.gov/coverage/outpatient-mental-health-care.html

If the website filters botch up the link, google "Medicare, coverage for psychiatric care". It's the first hit after the ads.
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Bumping my question up. I certainly hope someone has had Medicare cover a psychiatric visit.
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