Aging With Dignity

Costs and Wait for an Appointment:
At The Memory & Attention Center we accept Medicare, which pays 80% of the amount they set. That leaves 20% copayment which is about $120, which secondary (Medigap) insurances usually pay, but is what you could expect as an out-of-pocket expense. Keep in mind, early in the new year, there is an additional $100+ deductible for all Medicare Part B outpatient services; i.e., for any doctor you see. Your secondary insurance may, or may not, pay that. The rate Medicare allows per hour for mental health services is extremely low (about $30 less than your car mechanic charges) and if a professional contracts with Medicare, then they must accept the rate that Medicare allows.

Many doctors have stopped taking new Medicare patients, but mental health providers are dropping out of the Medicare system. For example, we know of are no psychiatrists in private practice in Southern Mass. (probably most of the state) taking new Medicare patients. Medicare has gradually lowered our rate for testing by over 40% over the last 12 years. Medicare now reimburses mental health providers less then MassHealth/Medicaid does for indigent people. Thus, there are very few (we appear to be the last in southern Mass) of us left doing this work and our typical wait time for an evaluation is between 7 and 9 months for a Medicare case.

If we are not providers for your insurance, we could set up an appointment quickly, often within a week or two, for a “private pay” evaluations; e.g., if a patient does not have standard Medicare. The cost is less than what you would pay for a root canal, and less painful! By doing a few private pay cases at our usual and customary rate, that income subsidizes our losses in performing Medicare evaluations. Some people prefer to pay privately to get seen sooner; however, you have to meet certain criteria for this option as we are required to accept Medicare in most cases, which puts you in the queue (waiting line) for the next available Medicare appointment.

Since we are contracted providers, if you have standard (traditional) Medicare or a Blue Cross insurance, we can only do a private pay evaluation if the referral reason is non-medical; for example to assess a person’s capacity to make decisions, to drive, manage their finances, choose or refuse an assisted living placement, alter a will, select a HCP or POA, need for guardian or conservator, assess Long-term Care insurance eligibility, etc.

If you don’t have traditional Medicare (e.g., you have an Advantage Plan, or a Medicare replacement product, like Tufts or Harvard Pilgrim, etc.) mention that when you call. We have to complete a Prior Authorization form and send it to your insurance company to see if they will approve an “out-of-network” service with us. They often will, as otherwise you would have to go to Boston to find an "in-network" provider. Still it takes time to fill our all that paperwork and wait for a response. If we are not "in-network" providers for your insurance, you might consider privately paying, but if you seek reimbursement from your insurance company that will likely fail. The good news is we can usually see you far more quickly, for a cash pay evaluations.

If you have a non-medical issue (e.g., a lawyer is involved or you have competency questions) or non-standard Medicare, tell us. You may have to pay out-of-pocket, but we can see you quickly. Call to ask us about a private pay evaluation.

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