Outpatient Health Insurance Information

Three Categories:

A.      Medicare - Federal
1       Age 65 or Older
2       Disabled
3       Chronic Renal Disorder
Assigned: Participating providers agree to accept approved amount of charges. The patient is responsible for:
1   Any Deductible
2   Co-Pay and some Non-Covered Charges
Non-Assigned: Medicare payment sent directly to recipient and the recipient is responsible for difference between Medicare and physician’s charge 

B.    Medicaid – Federal & State
(Many physicians do not accept Medicaid, but those who do bear all costs.)
1   Low Income
2   Age 65 or Older
3   Blind
4   Disabled

Mental health professionals vary on whether they are Medicaid providers.

C.   Private Insurance Carriers:
A contract between the carrier and insured provides for specific coverage. A deductible that the individual must pay may apply, and after this is satisfied, benefits are paid based on the contract agreement (i.e. 80/20).



 

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