Billing Part B for Mental Health

[RamonV36315]

My wife has Part B benefits and saw a mental health therapist who doesn't accept insurance. She attempted to bill Part B, to then send to her secondary. She sent the claim herself to the address online but has not received any response in over 6 months. When she goes online there is not record of the claim. What do we do?

[ReTiReD51]

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@RamonV36315  

This is the Form CMS 1490  you need to submit to the correct Medicare Administrative contractor for your STATE.

But first my suggestion is to contact your state’s department of insurance and their Senior Health Insurance Information program SHIIP and ask them for help.

SHIIP is a national program that provides free unbiased one-on-one assistance, counseling, and education to Medicare beneficiaries. Funding is provided by the federal government.

[somarco]

@RamonV36315 Medigap plans are not obligated to pay claims denied by Medicare. If they did so, they would be a primary carrier, not secondary.

If the therapist has opted out of Medicare, like many do, you should expect to pay as billed.

Use this link to find therapists in your area that participate in Medicare.

https://www.medicare.gov/care-compare/

[GailL1]

@somarco 

I didn't see where the OP mentioned Medigap as secondary.

Some secondary coverage insurers have different coverage parameters than Medicare but are processed in the same manner since Medicare is primary.  In this type instance, Medicare is only primary because of the claims processing hierarchy. 

Under my Medicare secondary insurer, which is not a Medigap, the claims are submitted to Medicare, they pay or not (denial), for the service and as normal, the claim is then passed along to the secondary insurer and they do the same, pay or not but under this type of arrangement the pay or not is not only based on the amount that Medicare might pay, it is also based on what coverage the secondary insurer has in their plan.

I have had several instances where Medicare paid nothing, and my secondary insurer paid all or some of the claim.  I understand their actions in this regard because I understand what, who and how each plan works - together and independently.  

I guess I figured the OP knew the difference in a Medigap plan and a secondary insurer - but who know.

[GailL1]

1st Pay the bill and then move forward to get reimbursed from the 2nd payer if they cover the service.

If YOU, not the uninsured provider of the service, filed the claim according to this (linked) guidance and it still isn't showing up - it sounds like it didn't get processed at all.

Medicare.gov How Do I File A Claim

You may need to submit again, and I would include a brief note as to what you are trying to do in getting to the 2nd payer for their processing after the Medicare denial (see you should have at least gotten this if it had been processed at all by Medicare).  

You have to get it done cause there in 1-year clock a'tickin

[ReTiReD51]

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Medicare Coverage for Mental Health Services

"some psychiatrists do not accept Medicare (or even any insurance in some cases).  So be aware that if you go to a psychiatrist who has opted out of Medicare, you will be responsible for the total bill and Medicare won’t reimburse you" 

[clarachan]

I have been very frustrated as there is no mental health care covered here under AARP MEDICARE ADVANTAGE UNITED HEALTHCARE--NOTHING--I have looked for a therapist literally for YEARS--NO OPENINGS ANYWHERE IN WESTERN OREGON!!!NOT IN Eugene, Springfield, not Portland--nada!!  no there are NO PSYCHIATRISTS LEFT IN OREGON--THEY ALL LEFT the state,They refuse to take Medicare amd medicaID. HONEST!! MEDICAL people have left Oregon, as a huge group,to other states,they hate the govt, insurance here.---I have tried to get a therapist for years--one just dumped me cause im too depressed for her,.HAH.--Shes an "amatueur"(spelling)from a poor free clinic. Who is so bad, they can't stand depressed PATIENTS?STUDENTS!! But, no, Unitedhealthcare medicare advantage aarp does NOT COVER MENTAL HEALTH. IM NOT EXAGGERATING. I wish i were,.Your insurance probably does not cover it either--insurance companies hate covering mental health.--So your govt, type insurance may not cover it at all, You know when i get very depressed,and i get bad headaches?I go to a nuerologist.They cover exaCTLY THE SAME MEDICINE THAT PSYCHIATRISTS USE.--I am very depressed now,horrible headaches,the only thing left is a nuerologist--It   is the same BRAIN.EXACTLY the same.--But the only medical doctor for my depression with headaches is a "physical medicine"doctor..I hate to tell you this,mental illness is so discriminated against, insurances refuse to cover it often.--It used to be,mentqal illness USED TO HAVE "Advocates"and programs--not any more.Why do you think all those mental people are homeless?They're not all drunks and addicts.---Lots of severely mentally ill are all over our streets.--sometimes in jail.--no institutions left either, they were all emptied.    I cannot pay a huge amt. of money to see real therapists,and all the medicare & medicaid is refused generally.There are waiting lists for years that never move.--Unless you can pay $$$ cash, its hard to find therapists now. You know what?I have to talk a few minutes to "senior lonliness lines" or "Warm lines,"or "suicide hotlines"for a couple minutes---they are overwhelmed too. My cat keeps me alive and feeling like she really needs me. --much more than any expensive therapist. Oh, and other than nuerology, my internest is my "therapist".My poor gp--I go to talk to him, at times,he even understands "depression" as a real medical disease.--Excellent doctor,they over work the poor guy. So, yes, imagine GPs and internsts having to handle very mental problems; its true. Medicare just is not attracted to anyone else except your gp; they often have to handle it now.I would not be a doctor for anything now; my sister'as doctor just QUIT HER JOB.--completely. She's so spent,she can't work any more.--Kaiser Permanente in California.--The poor woman is a wreck, wasted, she can no longer do it.--Can you imagine a time where doctors are aLL GETTING NERVOUS BREAKDOWNS AND EXAUSTION? it is happening.  There are self help books, too.I've had to use them for this.Even books on "Anger Management."Often they work. I'm trying to help. Sorry!!!I wish i could help you  more. 🙂