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. The rate Medicare allows per hour for mental health services is extremely low and if a professional contracts with Medicare, then they must accept the rate that Medicare allows. Thus, there are very few (we may be the last in southern Mass) professionals doing this work and our typical wait time for an evaluation is between 7 and 9 months for a Medicare case. We know of no private psychiatrists accepting new Medicare patients in southern Massachusetts, because of the low rates they allow to all mental health providers.

However, we can set up appointments quickly, often within a week or two, for “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 a lot less painful! The math is simple, 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.

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 there is only a medical reason a patient is referred (e.g., Does s/he have neurocognitive impairment or dementia?), than we are obligated to take Medicare and/or Blue Cross, and we will give you the next available insurance-based appointment. We are working to increase out staff, but finding specialists in neuropsychological evaluation willing to come to the Cape, develop geropsychiatric skills and work at Medicare rates takes years. Note: Medicare now reimburses mental health providers less then MassHealth/Medicaid does for indigent people.

If you don’t have traditional Medicare (e.g., you have an Advantage Plan, or a Medicare replacement product, like Tufts Secure Horizons or Harvard Pilgrim, etc.) mention that when you call. If we are not "in-network" providers for your insurance like Tufts, then we don't bill them. We see you on a private pay basis, and then you seek reimbursement from a portion of your payment–but don't count on it. 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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