Medicare
How many parts of Medicare are there? Name them
4
Medicare Part A,B,C,D
Alain Vilatte/Peoria, IL
What is the provider's Specialty?
10201 Family Practice
Par Provider Bills: $300
Par Provider allowed: $200
Member’s Copay: $75
What will the member owe?
$75
Brock Jackson
10240 West Indian School Phoenix AZ
What is the PIN?
7419686
Open Access (HMO) plans requires the member to have a pcp? True or False
False
Who is eligible for Medicare?
65 & Older
Under 65 with certain disabilities
People with ESRD (End Stage Renal Disease)
Alain Vilatte/Peoria, IL
What hospital is this provider affiliated with?
OSF Saint Francis Medical
Par Provider Bills: $300
Par Provider allowed: $200
Member’s Copay: $75
What will Aetna's responsibility be?
$125
Using TIN 371744475 address 1661 East Camelback Rd phoenix, AZ
What is the specialty?
20101 Ob-GYN
Open Access (HMO) plans have both in and out of network benefits? True or False
False
Medicare Beneficiary Identifier ALSO know as the Medicare #
Using TIN E 223293121/Matthew Krupnick/Dover,NJ
What is the provider's PIN & Specialty?
PIN 5987094 & Gastroenterology
Par Provider Bills: $500
Par Provider allowed: $250
Member’s copay: $275
What will the member owe?
$250
Who is the owner of TIN E-205198811?
Arizona OBGYN Affiliates
We only offer Prescription Drug Plans (PDP) to our member's? True or False
False---We offer both MAPD and PDP plans here at Aetna however we will only handle MAPD plans.
If you have both Medicare and Medicaid you are considered what?
Dual Eligible
Using TIN E 223293121/Matthew Krupnick/Dover,NJ
How many HMO plans does the provider accept?
None and that is because all of his contracts are expired
Par Provider Bills: $400
Par Provider allowed: $250
Member’s deductible: $500
What will the member pay and why?
$250 because the allowed amount is only $250. That $250 will go towards the member's deductible. We will NEVER have our member pay more for a service than what we would pay.
Clark Huang
What is his service location address?
115 East 57th St
Ste 600
New York, NY 10022
What is the main difference between a local PPO plan and a ESA PPO plan?
They both have in and out of network benefits however on the Local PPO plans if the member uses the out of network benefits the cost share is higher. On the ESA PPO plan whether the member goes in or out of network the cost share is the same for the member.
When a member becomes Medicare eligible they must have what in order to avoid a LEP?
Creditable Part D coverage
Using PIN 7419686 what is the billing address?
P.O Box 19171
Belfast ME 04915
Par Provider Bills: $500 Par Provider allowed: $300 Member’s deductible: $500
Deductible met as of today: $200
How much does Aetna pay and why?
$0 and that is because the member has $300 left to pay to meet their deductible and that is the allowed amount so Aetna doesn't pay anything on this claim. Aetna won't pay anything on the claim until the deductible has been met.
Using PIN 7379111 does the provider accept a DSNP plan? Which one?
Yes----NY DSNP Medicare HMO
All DSNP members will not have to worry about premiums, deductibles or copays for covered medical services? True or False and why
False----It depends on the level of Medicaid that the member has. If they have FULL Medicaid benefits then they will not have to worry about about paying anything. If they have partial Medicaid benefits then they may have to pay some cost sharing for covered services.