Wiki Reimbursement...yes or no??

[leasiepops]

Hi,

I bill for a chiropractor in La Jolla, CA who is non-par for Medicare;however, she is in-network with UHC.

My question is the patient has forfeited Medicare and has UHC Medicare Solutions. So, can the provider be reimbursed for spinal manipulations through UHC or is she still considered non-par?

Personally I thought she would not receive reimbursement because UHC would following Medicare guidelines (she is non participating with Medicare). All claims have been denied; however, we did receive payment on a couple in September from UHC...so I'm totally confused.

Any advise would be greatly appreciated!

Thank you.

 

[DIANA0331]

Reimbursement or not answer

Medicare advantage plan will cover for the services even though physician doesn't participate with Medicare. In other scenario physician participates with Medicare a no with the company under which patient has the Medicare advantage but the pt has oon benefits then physician will get paid