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.
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---😷😷😷😷😥😥😥😵😵😵😵!!!
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.
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!!!!!!!!!!!
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".
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.
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.
See All Answers