Medicare & Medicaid

Medicare

        As you are probably aware, Medicare determines what they will approve and what they will pay for each and every service.  We are better able to assist you because we submit all Medicare claims electronically.  This speeds up your payments and allows us to receive back other information quickly.  We will also be happy to assist you in answering any questions regarding your secondary insurance billing.

1. Soderstrom Dermatology Center, S.C. does accept assignment with Medicare Part B.  This means that we charge the Medicare allowed rates.  Medicare will pay 80% of these allowed charges.
2. THE AMOUNT YOU MAY BE BILLED for Medicare Part B services:
   • An annual deductible - the first $124.00 (for 2006) of Medicare Part B charges processed each year.
   • A co-insurance amount - 20% of the amount charged after the deductible has been met for the year.
   • Charges for services or supplies that are not covered by Medicare. 
   • Charges for which you signed an ABN waiver.
   • Cosmetic services are available to all patients and are not billed to your insurance. 
   • All of these are determined by your individual insurance plan.
3. If you have supplemental insurance, it may help to pay the amounts that you may be billed.  We will bill your supplemental insurance for you.
4. If you have no other insurance, you will need to pay 20% of services at the time of service. 
5. Medications are not covered by Medicare.
   • Prescription medications (no drug card with insurance coverage) can be purchased here and paid for at the time of service.
   • Prescription medications (with a drug card) - Let us know and we can give you a prescription, which you can have filled at a pharmacy.
   • Over-the-counter medications are not covered by insurance companies.  These can be purchased here and paid for at the time of service.
6. Pathologies read here are covered by Medicare and are billed through our office within a few weeks of your office visit.  Labs and blood tests are covered by Medicare and are billed through Methodist Lab.  Should you have questions, you can call the Methodist Lab at (309) 671-5199.  Some original and all second opinion pathologies are billed through Proctor Hospital Lab or Mayo Reference Lab.  The Proctor Lab number is (309) 691-1000.  The Tazewell Pathology group will bill you for any co-pays that are due.  You can reach them at (309) 693-2630.  The Mayo Reference Lab number is 1(800) 533-1710.
7. For more information about services covered by Medicare, please see your Medicare Handbook.  For billing questions, call the Medicare Beneficiary Line at 1(800) 642-6930.

Medicaid - Illinois Public Aid

        If you are relying upon the Illinois Department of Public Aid for Medicaid services, we require that you present your IDPA card every time you visit our office.  The IDPA recommends that we should provide no service unless we can verify current eligibility.

1. Soderstrom Dermatology Center, S.C. does accept accept assignment with Illinois Public Aid/Medicaid.  Medicaid will pay their approved amounts for these charges directly to Soderstrom Dermatology Center.
2. THE AMOUNT YOU MAY BE BILLED for Medicaid services:
   • A $2.00 co-pay due for each office visit.
   • Any annual spenddown amounts.
   • Charges for services or supplies that are not covered by Medicaid.
   • Charges for which you are signed an ABN waiver.
   • Cosmetic services are available to all patients and are not billed to your insurance.
   • All of these are determined by your individual insurance plan.
3. Medications are not covered by Medicaid.
   • Prescription medications can be purchased here and paid for at the time of service.
   • Prescription medications can also be purchased at a pharmacy - Let us know and we can give you a prescription or call in your prescription. 
   • Over-the-counter medications are not covered by Medicaid.  These can be purchased here and paid for at the time of service.
4. Pathologies read here are covered by Medicaid and are billed through our office within a few weeks of your office visit.  Labs and blood tests are scripted and can be performed at the facility of your choice.  Some original and all second opinion pathologies are billed through Proctor Hospital Lab or Mayo Reference Lab.  The Proctor Lab number is (309) 691-1000.  The Mayo Reference Lab number is 1(800) 533-1710.  The Peoria-Tazewell Pathology group will bill you for any co-pays that are due.  You can reach them at (309) 693-2630.
5. For more information about services covered by Medicaid, please see your Medicaid Handbook.  For billing questions, call your Illinois Public Aid assigned caseworker.

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