What Medicare Won't Cover

Confused about Insurances, Yet?
Of course you are, and we are often too. Feel free to give us a call for information. Ultimately, the patient (we often ask family to cosign as guarantor) is responsible for the full cost of the evaluation when insurance does not pay. We cannot call and find out what or how much your insurance will pay or how much of your deductible is left that you need to spend cash on as that is HIPAA protected Personal Health Information.

If You Don’t Have Medicare, or if you have a Medicare Replacement Product
The average evaluation takes at least four, often five and sometimes six hours and costs between $1000 to $1500, unless we notify you otherwise. The cost for our half-day home visit evaluation is about the same as the cost of one-hour root canal, and much less painful!

Hospitalizations, etc.
While Medicare does pay for emergency services, it will not pay for completion of the essential paperwork involved in a Section 12(a) to arrange a psychiatric hospitalization. We will charge you for the time involved. However, we also will advise you and complete specialized paperwork allowing Medicare to pay for the ambulance ride, typically about $600 to $1000+ for people living on the Islands. You can’t use your local fire department ambulance team as they are required to transport only to your nearest emergency room, not a psychiatric hospital where we would have prearranged a bed.

Guardianships, Competency Evaluations, etc.
Competency evaluations are for
legal purposes (not medical) and are not reimbursed by Medicare, which pays only for medical care. A neurocognitive evaluation must to be done before we can complete a Medical Certificate (MC) for guardianship or conservatorship. This is not covered by Medicare. Preparing the MC for the court, or reports for agencies and long-term care insurance companies, and documents are not paid for by insurance. See the next section, For Attorneys, for more details.



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