Medicare Replacement Primary, Medicaid Secondary

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Important Information

Patient has a commercial insurance as primary, and a Medicaid plan as secondary. We will show the regular benefits with patient’s commercial insurance, but understand the following:

If patient’s care goes to the commercial insurance’s deductible, Medicaid will cover the charge at the Medicaid allowed amount (for spinal manipulations, and for exam and x-rays on first visit of diagnosis).
If patient has co-insurance or a co-pay due with commercial insurance, we will follow the co-pay amount for Medicaid instead.

Medicare Replacement Primary, Medicaid Secondary

Note: This patient has a Medicare replacement plan as primary, and a Medicaid plan 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.

Medicare Replacement Plan is Primary

Deductible per calendar year

How much deductible left to meet for this year?

Co-pay for Spinal Manipulation

Co-insurance for Spinal Manipulation

Additional Information

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.

Medicaid is Secondary

State

Important Information

Medicare Deductible - If any deductible is left to meet for the year with the Medicare Replacement plan, Medicaid will cover it for spinal manipulations.
Co-pay for spinal manipulation - Zero. Even if the Medicare Replacement plan shows a co-pay, the patient will not be responsible for it. Medicaid will cover the co-pay amount up to the Medicaid allowed amount for a spinal manipulation.
Exams/re-exams - Medicaid will cover exam on the first visit of diagnosis. No copay.
X-rays - Medicaid will cover up to 3 x-rays on the first visit of diagnosis. No copay.
Therapies - Not covered by Medicare or Medicaid. Patient responsibility.
Chiropractic Maximum - 20 visits per diagnosis with Medicaid. A new diagnosis can be done after 20 visits if more care is needed. When a new diagnosis is done, an exam and x-rays can be charged if they are performed on that initial visit of diagnosis.

Important Information

Medicare Deductible - If any deductible is left to meet for the year with the Medicare Replacement plan, Medicaid will cover it for spinal manipulations.
Co-pay for spinal manipulation - Zero. Even if the Medicare Replacement plan shows a co-pay, the patient will not be responsible for it. Medicaid will cover the co-pay amount up to the Medicaid allowed amount for a spinal manipulation.
Exams/re-exams - Medicaid will cover 1 exam per year. It has to be on the first visit of diagnosis.
X-rays - Medicaid will cover up 1 x-ray per year. It has to be on the first visit of diagnosis.
Therapies - Not covered by Medicare or Medicaid. Patient responsibility.
Chiropractic Maximum - 24 visits per year with Medicaid (no more than 6 visits per month).

Important Information

Medicare Deductible - If any deductible is left to meet for the year with the Medicare Replacement plan, Medicaid will cover it for spinal manipulations.
Co-pay for spinal manipulation - Zero. Even if the Medicare Replacement plan shows a co-pay, the patient will not be responsible for it. Medicaid will cover the co-pay amount up to the Medicaid allowed amount for a spinal manipulation.
Exams/re-exams - Medicaid does not cover exams. We cannot charge patient for exams if they have Medicaid.
X-rays - Medicaid will cover up 1 x-ray per year. It has to be on the first visit of diagnosis.
Therapies - Not covered by Medicare or Medicaid. Patient responsibility.
Chiropractic Maximum - 18 visits per year with Medicaid.

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.