Mental Health coverage through Medicare (psychiatrist, medication, insurance, therapy)

[sfcambridge]

I posted this in the Medicare board, but probably this is a better place.

Does anyone have knowledge/experience with mental health coverage through Medicare?

From my reading of their website, claims for doctor visits that are for diagnosis and medication management should be reimbursed at the usual 80%. However, visits for "treatment"... such as for psychotherapy, are reimbursed at 65%.

Does anyone ever have a claim go through that is reimbursed at 80%?

All of my Dad's seem to be 65%. This is surprising to me, as the reason we were sent to a geriatric psychiatrist was for "medication management". He has a lot of medical problems/medications and we modify multiple meds every visit. For each visit, the doctor files two claims.... one for a clinic visit/evaluation and management, and one for psychotherapy. Both paid at 65%.

I know starting in 2014, all mental health claims will be covered at 80%, just like other claims. yippee!

I called Medicare and asked why some claims are paid at 65% and not the 80%... they couldn't tell me, and said "Ask your doctor". The doctor has no idea. Most doctors have no idea how billing is done, and he looked even more stressed/tired then me when I asked him....

Any input appreciated. This difference in coverage is significant for my Dad, as his secondary insurance is a retiree plan through the State of IL... which is broke.... so they are drastically cutting retiree health benefits to try to save money.