[dbussone]

Originally Posted by gerryann

They do have a medicare advantage plan. But I thought it was an hmo.

Gerryann - what do you think about blueash's post regarding coding? That seems plausible to me.

[gerryann]

Originally Posted by dbussone

Gerryann - what do you think about blueash's post regarding coding? That seems plausible to me.

Makes sense. When I worked with Medicare and submitted claims.....more often than not, claims were submitted, resubmitted and many times a third time. Medicare has always been a stickler with proper coding. And of course would only pay for one if only one code was allowed. However, when I was doing it, they allowed multiple Codes per visit. Not sure now if only one CPT is allowed.

[Villages PL]

Perhaps it may help to know that my insurance card says: Freedom Platinum Plan Rx (HMO)

Procedure..................Code...............Char ged.......................Paid

99397 PERIODI............C20................203.00...... ..................0.00
C PREVENTIVE
MED EST
PATIENT 65YRS&
OLDER

G8418 BMI DOC............391...............0.01..........ALL OWED 10.00........... PAID 10.00
BLW NML PARAM
& A F/U PLAN
IS DOCUMENTED

EOB Explanation:

391 Payment is fee schedule based

C20 "Capitated payment, no member liability"

[dbussone]

That helps immensely. A traditional HMO with capitation. As I guessed.

[gerryann]

I certainly could be wrong but, I believe CPT codes 99391 thru 99397 are currently NOT covered by Medicare. I would guess that if your Doc has a good insurance person, they will resubmit (legally) with a new acceptable code.

[Villages PL]

I just remembered something: I believe most HMOs like Freedom only offer one free checkup per year. Being that it was my doctor's idea to have me come in for 2 checkups, one is not paid for. (I don't need 2 checkups.) I wonder who pays for the blood work?

[dbussone]

[QUOTE=gerryann;1056710]I certainly could be wrong but, I believe CPT codes 99391 thru 99397 are currently NOT covered by Medicare. I would guess that if your Doc has a good insurance person, they will resubmit (legally) with a new acceptable code.[/

Gerryann- Why wouldn't Medicare cover that general range of codes.?

[gerryann]

Wish I knew. Medicare has some strange rules....I do know that.

[blueash]

thanks for posting your eob. What I would suggest this says is that certain services are covered under the monthly check that the insurance sends to your doctor whether (or weather) or not you are seen. Dr. X gets a check for having you on his panel. Now the periodic well exam is one of those services. So it is not that he is not being paid, he is expected to do well exams on you, as many as he thinks you need. So he is getting paid, just not as a fee for service.
The $10 payment is for recording your BMI and making a plan to address any nutritional concerns related to your BMI. I'm not sure why that would even be an additional payment so it is nice they gave that amount.
Does not seem to have been a charge listed for the ear cleaning.

[Villages PL]

Originally Posted by blueash

thanks for posting your eob. What I would suggest this says is that certain services are covered under the monthly check that the insurance sends to your doctor whether (or weather) or not you are seen. Dr. X gets a check for having you on his panel. Now the periodic well exam is one of those services. So it is not that he is not being paid, he is expected to do well exams on you, as many as he thinks you need. So he is getting paid, just not as a fee for service.
The $10 payment is for recording your BMI and making a plan to address any nutritional concerns related to your BMI. I'm not sure why that would even be an additional payment so it is nice they gave that amount.
Does not seem to have been a charge listed for the ear cleaning.

Thanks for the information.

My BMI might not be where they want it to be. It's about 18 and I assume they might prefer 18.5, although they have never stated this. I'm getting full at every meal with all healthy foods. And I have a gerontologist's book to back me up stating that a BMI of 18 is ideal, assuming one gets optimal nutrition.

I hate to complicate things but I just realized that my doctor doesn't work alone. He belongs to a group known as "Florida Medical Associates". It's a professional corporation consisting of 12 doctors, according to their website. (I just checked the website for the first time.) There's a group picture in his office consisting of about 50 or more employees and he's in the picture. I believe he said it includes everyone who works for the organization. I just remembered him saying that a couple of weeks ago. I believe he's an employee of this organization. On their website it says they are looking for more doctors to join their group. It says that doctors only have to see about 20 patients per day so they have more time to spend with each patient.

Here's a link: About Florida Medical Associates (FMA)

I suppose it means he gets a salary. I wonder who owns Florida Medical Associates, could it be the corporation that owns the hospitals?

[Nightengale212]

Originally Posted by Villages PL

Thanks for the information.

My BMI might not be where they want it to be. It's about 18 and I assume they might prefer 18.5, although they have never stated this. I'm getting full at every meal with all healthy foods. And I have a gerontologist's book to back me up stating that a BMI of 18 is ideal, assuming one gets optimal nutrition.

I hate to complicate things but I just realized that my doctor doesn't work alone. He belongs to a group known as "Florida Medical Associates". It's a professional corporation consisting of 12 doctors, according to their website. (I just checked the website for the first time.) There's a group picture in his office consisting of about 50 or more employees and he's in the picture. I believe he said it includes everyone who works for the organization. I just remembered him saying that a couple of weeks ago. I believe he's an employee of this organization. On their website it says they are looking for more doctors to join their group. It says that doctors only have to see about 20 patients per day so they have more time to spend with each patient.

Here's a link: About Florida Medical Associates (FMA)

I suppose it means he gets a salary. I wonder who owns Florida Medical Associates, could it be the corporation that owns the hospitals?

Thanks for providing the link where you receive Primary Care. Was just taking with a physician I work with in Primary Care at the VA and his wife dragged him on a TV Lifestyle visit last month kicking and screaming. He surprised himself by falling in love with the place and is seriously considering a move to TV when he retires in the near future. He would like to continue working part-time which this practice notes they hire part-time physicians. How ironic he even kept up his Florida license as he lived and worked in Naples some years back.

Will be passing on the link to him today