MyCare Program Cost and Coverage

MyCare Program Cost and Coverage 

Below you will find information about how Chronic Care Management (CCM) claims are filed to Medicare, what you can expect to see on your Explanation of Benefits (EOB), and Medicare Coverage.

• CCM Claims & Medicare Filing

  Your Medicare insurance policy will be billed monthly for (CCM) services provided through our MyCare Program and based on the following virtual interactions and outreach.

  Billable interactions include:

  • Phone calls with your MyCare Coordinator

  • Information sent to you via email or text, including MyCare Journey content

  • Clinical chart reviews by your Virtual Care Team (i.e. our Registered Dietitian)

  • Charting and documentation

    
    
    
    

  
  

   

• Your Explanation of Benefits (EOB)

  As a Medicare patient, you can expect to see an EOB any time a provider files a claim for your care.

  CCM Billing Codes and Associated Fees: All medical services have an associated billing code, which is sent to Medicare when your claim is filed. 

  Medicare Adjustment for Service: Medicare pays a predetermined rate for all billing codes.

  Date of Service (DOS): The DOS on your EOB corresponds to the last date that you received CCM services during the month, which is not necessarily the same date that you completed a call with your MyCare Coordinator. This DOS could correspond to any number of virtual interactions, communication, or care provided, such as an email, text message, or chart review. Please note that your DOS for CCM does not correspond to an in-office visit with your provider. 

   

• Medicare Coverage

  The CCM services provided through our MyCare Program should be covered by your Medicare plan. Most secondary insurance policies also cover any remaining balances related to CCM.

  However, you may be responsible for a small out-of-pocket cost for the program. If you do receive a bill, and it's a problem, please reach out to your Care Coordinator. We'll work on a solution so you can stay in the program which is recommended because:

  • According to Medicare, not only do CCM programs save the healthcare system money, but they also save you money in the long run by keeping you healthy and out of the hospital.

  • Studies have shown that the long-term benefits and cost savings of participating in these types of programs greatly outweigh the possible small monthly expense. 

  • The MyCare Program provides you the opportunity to collaborate with a dedicated MyCare Coordinator each month so you can be an active participant in your healthcare.