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CommentaryPreventive MedicinePrimary Care

Out-of-Pocket Mental Health Care Can Be Reimbursed by Medicare Supplemental Plans

By November 7, 2021No Comments

If you are on Medicare and pay directly for outpatient mental health services to a psychiatrist or psychologist or social worker who does not accept Medicare, you may be surprised to know that you should be eligible for substantial reimbursement of those expenses. Massachusetts law requires Medicare Part B supplemental plans to reimburse you for those outpatient mental health services at 100% of the reasonable and customary fee. This is clearly financially relevant since a substantial portion of psychiatrists and psychologists and social workers do not participate in Medicare.

Mass. law requirement not widely known

I believe many people if not most people on Medicare do not know that they are eligible for reimbursement for out-of-pocket mental health services. I have not yet been able to run down the precise legal citation, but this Massachusetts requirement was clearly stated in, for example, the Member Handbook for Fallon Companion Care Medicare supplemental plan. The availability for reimbursement was nicely hidden in a section titled “Services mandated by Massachusetts law.” I do not know whether other states have similar requirements.

Applying for reimbursement

If you are on Medicare and have unreimbursed out-of-pocket expenses for mental health services, by all means get out or look up the member handbook for your Medicare supplemental plan. There should be information in there as to how to apply for recompense. It will require a form, of course, and submitting certified paid bills with appropriate coding from your mental health provider. It’s annoying of course, but it should be productive.

Let us know how you do

While I believe this reimbursement process is a well-kept secret, I may be wrong. Please let us know if this is news to you, or if you have already availed yourself of it. I also am not sure that many mental health providers know this is a possibility.

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