Anyone used Medicare Chronic Care Management Services? (medical, plan, doctor)

[RMD3819]

https://www.medicare.gov/coverage/ch...ement-services

My wife is new to Medicare. She saw a new doc who told her about this and she signed up, apparently with the belief it would be covered 100% by Medicare and Cigna (secondary).

Is this expense worth it? I never heard of it until today.

[reed303]

Well, the CPT code appears to be 99490, according to:
https://www.cms.gov/Outreach-and-Edu...Management.pdf

Billing varies by locality and facility, but appears to range from about $35 to $55

https://www.cms.gov/apps/physician-f...3&H1=99490&M=5

[Travelassie]

Originally Posted by RMD3819

https://www.medicare.gov/coverage/ch...ement-services

My wife is new to Medicare. She saw a new doc who told her about this and she signed up, apparently with the belief it would be covered 100% by Medicare and Cigna (secondary).

Is this expense worth it? I never heard of it until today.

Any billing to the patient would be subject to the same conditions they have under the terms of their Medicare coverage. That is, if they have traditional Medicare with a supplement, Medicare would pay 80% of their determined reimbursement costs for this service with the supplemental insurance picking up the other 20% (with any copay and/or deductible according to the terms of the coverage). Payment for the service under a Medicare Advantage plan would depend on copays under a patient's contract with the plan.

That said, the program is intended for people who have been diagnosed with three (though in some of the Medicare PDF verbiage I think I saw two or more???) chronic conditions expected to last either at least a year (depending on where you read), or for the rest of the patient's life and might be expected to lead to death if not controlled. Looking at the list of conditions (didn't look all inclusive, either, but that'd be the judgement of healthcare providers, I'd think), it seems to me many if not most seniors would qualify.

Though personally I know I would decline, as the intrusion by healthcare providers monitoring aspects of my healthcare that I'm perfectly capable of managing myself would drive me up a wall. I don't need anyone making sure I make doctor's appointments when indicated, that I fill prescriptions for medications timely and that I am compliant in taking those drugs as directed, that I'm not engaging in behavior that would worsen these conditions. And I sure don't need anyone pushing social services I don't want or need so they can collect payment for "managing" my chronic conditions.

Fortunately my PCP feels the same way. Several years ago when I had my annual physical, the nurse handed me a brochure describing the Medicare Chronic Disease Management program, told me I qualified for it (as I'd say most seniors do, sooner or later). She instructed me to read it and let the doctor know if I wanted to sign up for it. I read through the brochure, and concluded it was not for me (not being big on the "nannycare" attitude of Medicare in any case). I'd planned on handing the brochure back to the doctor and telling her, "thanks but no thanks". But she beat me to it. As I handed her back the brochure, she laughed and said, "you don't need that!".

Not that there aren't people who would benefit from this program. If one has difficulty understanding their medical issues, doesn't have the resources (be they physical, mental or emotional) to seek out or get the care they need to manage their conditions, such a program could be a godsend to them.
But IMO, if one can manage one's chronic issues successfully themselves, they should do so

[RMD3819]

Thanks for the comments and links.

This seems to have some concierge elements to it although some things seem standard like the electronic medical records-why pay for something we get already? Years ago our doc went concierge. Wife stayed on and paid the fee which I think was $1800. I found another doc. A year later she realized she didn't use any of the concierge perks so she found another doctor.

I don't really think she needs the monitoring and extra attention this service brings. We'll have to see what shakes out to see if there is value in it. Knowing her she assumed "free" and said OK.

She hasn't met her secondary deductible so I suspect if we get a bill every month for the 20% Medicare copay I suspect she will want to revisit this. I know I will if the value is lacking.