Wiki Medicare, Private Payers and Mental Health Professionals

[embatchelder]

I bill for a Clinical Psychologist who has opted out of Medicare. She has a new client hoping to see her who has 1. Medicare, 2. Aetna Retiree (self), and 3. Aetna Retiree (spouse). I am woefully underinformed when it comes to Medicare and was hoping someone who knows more about it could help me with this. From what I've read, since the provider opts out the patient will be responsible for payment in full. Can we bill secondary and tertiary? How? What is the least painful way?

 

[sls314]

You need to call Aetna and find out how (or if) they will pay when Medicare is primary, but the provider has opted out of Medicare. It depends on how the Aetna benefit plan is structured.

It's possible that the patient's secondary (Aetna retiree for herself) would not pay anything if Medicare doesn't pay anything.

It's also possible that the patient's secondary would calculate what Medicare would have paid as primary, and then pay based on what they'd normally pay as secondary if Medicare had actually paid.

In theory, it's also possible that they could pay the full Aetna allowed amount. (Though I suspect that might be a less likely scenario.)

I definitely recommend a phone call though. I know phone calls to insurance can be a pain, and I personally prefer to use my online resources whenever possible. But this is one situation where I'd actually make a call.

Good luck!