Medicare Replacement Plan Primary, Commercial Insurance Secondary

This patient has a Medicare replacement plan as primary, and Commercial insurance as secondary. The Medicare replacement plan takes the place of Medicare. We do not bill to Medicare. We bill to this Medicare replacement plan as primary. We will also show the Commercial Insurance benefits. We will show how the Commercial Insurance will coordinate with the Medicare Replacement Plan.

Medicare Replacement Plan is Primary

• Exams/re-exams - not covered by Medicare Replacement Plan (but recommended to do on first visit of new diagnosis).
• X-rays - not covered by Medicare Replacement Plan.
• Therapies - not covered by Medicare Replacement Plan.
• Chiropractic Maximum - no chiropractic maximum per year, but has to be medically necessary. Medicare Replacement Plan can do a records review if care goes on too long.
• Pre-authorization - not required.

Commercial Insurance that is Secondary

In Network Benefits

Individual Deductible

Insurance Benefits

Spinal Manipulations - After Deductible is Met

Exams/re-exams - After Deductible is Met

X-rays - After Deductible is Met

Therapies - After Deductible is Met

Chiropractic Maximum

Pre-Authorization

Out of Network Benefits

Individual Deductible

Insurance Benefits

Spinal Manipulations - After Deductible is Met

Exams/re-exams - After Deductible is Met

X-rays - After Deductible is Met

Therapies - After Deductible is Met

Chiropractic Maximum

Pre-Authorization

Coordination of Benefits between the two insurances