Medica Replacement Plan – Advocate Insurance Billing

Medica Replacement Plan (if clinic out of network with Medica)

Tools > Insurance Verification Type > Medica Replacement Plan

Today's Date*
MM slash DD slash YYYY
Patient Name*
First Last
Hidden
Phone*
Hidden
Email*
Clinic*
Note
This patient has a Medica replacement plan. We will bill Medicare as primary. Medica will most likely not cover any chiropractic care. So patient will have just regular Medicare coverage.
Clinic’s Participation Status
- Participating provider with Medicare
- Non-participating provider with Medicare
Medicare Deductible
How much deductible left to meet for this year?
Additional Information
• Co-pay for spinal manipulation - between $7.60 to $8.30 (The co-pay amount is different for each doctor each year). • Exams/re-exams - not covered by Medicare (but recommended to do on first visit of new diagnosis). Patient responsibility. • X-rays - not covered by Medicare. Patient responsibility. • Therapies - not covered by Medicare. Patient responsibility. • Chiropractic Maximum - no chiropractic maximum per year, but has to be medically necessary. Medicare can do a records review if care goes on too long. • Pre-authorization - not required.
Additional Information
• Deductible left to meet for this year - Patient pays clinic in full for charges. Medicare sends any payment to patient. • Co-pay for spinal manipulation - Patient pays clinic in full for charges. Medicare sends payment to patient. • Exams/re-exams - not covered by Medicare (but recommended to do on first visit of new diagnosis). Patient responsibility. • X-rays - not covered by Medicare. Patient responsibility. • Therapies - not covered by Medicare. Patient responsibility. • Chiropractic Maximum - no chiropractic maximum per year, but has to be medically necessary. Medicare can do a records review if care goes on too long. • Pre-authorization - not required.
Additional Comments
Disclaimer
When we call on a patient's insurance and verify benefits, it is not a guarantee of payment by the insurance company and may vary according to the patient's individual plan when the actual claim is submitted. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member's contract at time of service. The patient responsibility amount provided is an estimate of cost. The patient must understand that their health insurance company may deny payment for the services received. The patient must understand that it is ultimately the patient's responsibility to contact their insurance if they want to know exact chiropractic benefits.