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 Post subject: Medicare Coverage
PostPosted: Mon Jun 16, 2014 9:57 pm 
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Dr. Junig,

Do you know much about Medicare and their coverage of Suboxone? We've had several members who have had problems with their doctors once they were covered by Medicare.

Is it legal for a doctor to charge cash payment if the patient has Medicare?

Any light on this subject would be highly appreciated.

Rule62

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 Post subject: Re: Medicare Coverage
PostPosted: Tue Jun 17, 2014 12:25 am 
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The problem is that medicare, like Medicaid, pay very poorly for psychiatric services. As an anesthesiologist I generally was paid at least $100/hr by medicare... but they pay a psychiatrist less than half that for an office visit. Medicaid pays less-- maybe $30 for a follow-up visit. What I find insulting is at the same time, they pay over $600 to run one urine test through the machine for a 10 minutes test for illicit substances! In other words, counting time, they pay the machine about 40 times more per hour, per patient, than they pay doctors.

Doctors are not required to treat anyone, UNLESS they have signed a participation agreement. I do not like being forced to treat people; I don't like to be forced to do anything--- so I 'opt out' of medicare. A doc can do that every two years. It is officially filed with the medicare carrier, and the list is published on line (the wall of shame). BUT-- the doctor has to agree to not bill medicare for ANY services during that time. In other words, if the doc takes call at the hospital and gets an old patient, the doc cannot get paid from medicare for that patient. Also, the doctor must notify patients in writing before they are seen, and the patients must sign a statement that they are aware that they could get the services covered, elsewhere.

Since I opt out, I am limited from many other jobs. I cannot work in any hospital or clinic part-time that serves medicare patients, because you cannot work in a way that 'forces' patients to use you. I can do my own practice, where people know they can walk in or walk out the door... but I can't work in an ER, where patients have little choice about treatment.

It is similar with Medicaid... but varies a bit between states. The main thing is that opting out is 'all or nothing'. You cannot opt out for addiction patients, and opt in for psych patients. A doc is either in the system, or out of it. My own opinion? I think it most fair if everyone paid the same amount, for the same services.... so I opt out of EVERYTHING--- including Medicaid, medicare, and all insurers. Business takes a hit, but if I provide services that are better than other doctor services, I will always have people who are looking for something special-- like the only doc who does email, or the only doc that serves you a beverage when you arrive. Little things.... but some patients appreciate being treated like humans, when they go to a doctor--- something that is rarely done these days!


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 Post subject: Re: Medicare Coverage
PostPosted: Tue Jun 17, 2014 3:36 am 
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So I imagine you got those student loans paid off, hey doc?





PSYCHE! :mrgreen:

As an aside, for your listening pleasure: Aldous Huxley - The Ultimate Revolution (1962), https://www.youtube.com/watch?v=LEXs3RspWyU

Rule's Q&A post derived it's impetus, from this discussion (in legal forum): suboxone-had-discharge-because-have-medicare-t10490.html

Hat's off to you for providing us this fine forum.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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