Medicare Primary, Commercial Insurance Secondary – Advocate Insurance Billing

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Medicare Primary, Commercial Insurance Secondary

Tools > Insurance Verification Type > Medicare Primary, Commercial Insurance Secondary

Today's Date*
MM slash DD slash YYYY
Patient Name*
First Last
Hidden
Phone*
Hidden
Email*
Clinic*
Important Information
This patient has Medicare as primary, and Commercial insurance as secondary. We will show the Medicare benefits. We will show the Commercial Insurance benefits. We will show how the Commercial Insurance will coordinate with Medicare.
Medicare is Primary
Clinic’s Participation Status
- Participating provider with Medicare
- Non-participating provider with Medicare
Medicare Deductible
Medicare Deductible
How much deductible left to meet for this year?
Important Information
- Co-pay for 98941 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
Important Information
- Deductible left to meet for this year - Patient pays clinic in full for charges. Medicare sends any payment to patient.
- Co-pay for 98941 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
Commercial Insurance that is Secondary
Name of Insurance Company
Clinic is
In Network Benefits
Individual Deductible
Amount per year
How much deductible left to meet for this year?
Deductible
Plan year runs from
Month/Day to Month/Day
Family Deductible
Amount per year
How much deductible left to meet for this year?
Insurance Benefits
Are the insurance benefits for spinal manipulations, exams, x-rays and therapies the same?
- Yes
- No
Co-insurance/co-pay that patient must pay per visit
After deductible is met:
% of the allowed in network rate?
Dollar amount?
Spinal Manipulations - After Deductible is Met
Co-insurance/co-pay for spinal manipulation
% of the allowed in network rate?
Dollar amount?
Exams/re-exams - After Deductible is Met
Co-insurance/co-pay for an exam/re-exam
% of the allowed in network rate?
Dollar amount?
X-rays - After Deductible is Met
Co-insurance/co-pay for x-rays
% of the allowed in network rate?
Dollar amount?
Therapies - After Deductible is Met
Co-insurance/co-pay for a therapy
% of the allowed in network rate?
Dollar amount?
Chiropractic Maximum
Chiropractic maximum type per year
Amount of Chiropractic maximum
Amount of Chiropractic maximum
Amount of Chiropractic maximum left to use this year
Amount of Chiropractic maximum left to use this year
Pre-Authorization
Is pre-authorization required for chiropractic care?
- Yes
- No
If yes, what are the procedures for this?
Pre-authorization Information
Out of Network Benefits
Individual Deductible
Amount per year
How much deductible left to meet for this year?
Deductible
Plan year runs from
Month/Day to Month/Day
Family Deductible
Amount per year
How much deductible left to meet for this year?
Insurance Benefits
Are the insurance benefits for spinal manipulations, exams, x-rays and therapies the same?
- Yes
- No
Co-insurance/co-pay that patient must pay per visit
After deductible is met:
% of the charged amount?
Dollar amount?
Spinal Manipulations - After Deductible is Met
Co-insurance/co-pay for spinal manipulation
% of the charged amount?
Dollar amount?
Exams/re-exams - After Deductible is Met
Co-insurance/co-pay for an exam/re-exam
% of the charged amount?
Dollar amount?
X-rays - After Deductible is Met
Co-insurance/co-pay for x-rays
% of the charged amount?
Dollar amount?
Therapies - After Deductible is Met
Co-insurance/co-pay for a therapy
% of the charged amount?
Dollar amount?
Chiropractic Maximum
Chiropractic maximum type per year
Amount of Chiropractic maximum
Amount of Chiropractic maximum
Amount of Chiropractic maximum left to use this year
Amount of Chiropractic maximum left to use this year
Pre-Authorization
Is pre-authorization required for chiropractic care?
- Yes
- No
If yes, what are the procedures for this?
Coordination of Benefits between the two insurances
Will the commercial insurance cover the Medicare deductible?
- Yes
- No
Will the commercial insurance cover the Medicare co-insurance for spinal manipulations?
- Yes
- No
If no:
Will the commercial insurance cover exams/re-exams that Medicare will not cover?
- Yes, see the amount that commercial insurance will pay for exams
- No
Will the commercial insurance cover x-rays that Medicare will not cover?
- Yes, see the amount that commercial insurance will pay for x-rays
- No
Will the commercial insurance cover therapies that Medicare will not cover?
- Yes, see the amount that commercial insurance will pay for therapies
- No
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.
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