Medicare Primary, Medicare Supplement Secondary Tools > Insurance Verification Type > Medicare Primary, Medicare Supplement Secondary Today's Date* Date Format: MM slash DD slash YYYY Patient Name* First Last Phone*Email* Clinic*Choose a ClinicBalanced Living ChiropracticComplete Balance ChiropracticCoulee HealthErickson ChiropracticGregory Bernard ChiropracticHonchel ChiropracticKaizen ChiropracticNemitz ChiropracticTruhlsen ChiropracticTruhlsen Chiropractic-HendricksRichard Wilson DCRiverside ChiropracticWeber ChiropracticWW AppletonWW BeavertonWW BloomingtonWW Burr RidgeWW Flathead ValleyWW Fort MillWW Grand RapidsWW Green BayWW JacksonvilleWW LargoWW LouisvilleWW MequonWW North PhoenixWW PensacolaWW RockfordWW SpringWW WaukeshaWW Woodbury (Empower Health)Medicare is PrimaryClinic’s Participation StatusParticipating provider with MedicareNon-participating provider with MedicareMedicare DeductibleMedicare DeductibleHow much deductible left to meet for this year?Medicare Supplement Plan is SecondaryDoes this plan cover the patient’s Medicare Part B deductible?YesNoDoes this plan cover the patient’s Medicare Part B co-pay?YesNoAdditional Information Does this plan cover the patient’s Medicare Part B deductible? Patient pays clinic in full for charges. Medicare supplement plan normally sends payment to patient. Does this plan cover the patient’s Medicare Part B co-insurance? Patient pays clinic in full for charges. Medicare supplement plan normally sends payment to patient.Co-pay for spinal manipulationCo-pay for spinal manipulationIs the clinic in Wisconsin?YesNoAdditional Information Exams/re-exams - paid in full by Medicare Supplement Plan. X-rays - paid in full by Medicare Supplement Plan. Therapies - paid in full by Medicare Supplement Plan. 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 Exams/re-exams - paid in full by Medicare Supplement Plan. Medicare supplement plan normally sends payment to patient. X-rays - paid in full by Medicare Supplement Plan. Medicare supplement plan normally sends payment to patient. Therapies - paid in full by Medicare Supplement Plan. Medicare supplement plan normally sends payment to patient. 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 Exams/re-exams - not covered by Medicare or Medicare Supplement Plan (but recommended to do on first visit of new diagnosis). Patient responsibility. X-rays - not covered by Medicare or Medicare Supplement Plan. Patient responsibility. Therapies - not covered by Medicare or Medicare Supplement Plan. 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 CommentsDisclaimer 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.Need help understanding this document? Watch this short video on Medicare Primary, Medicare Supplement Secondary!