WP E-Signature by Approve Me - Sign Documents Using WordPress -

PAYMENT FLUCTUATIONS IN THE BEGINNING OF EVERY YEAR

In the beginning of every year, Medicare beneficiaries are required to pay a deductible (around $200) before any Part B benefits/appointments (including Blue Moon benefits) are paid by their Medicare plan. Patients either have to pay the amount ‘out of pocket’ to the provider or by their Supplemental insurance plan (Plans C and F plan are the only Supplement plans that cover deductibles).

The deductible issue causes challenges for Blue Moon as a whole in terms of attempting to collect funds from clients and/or having therapist’s assist in that process as well as all of the accounting required. If we wait until patient’s deductibles are met, we can then resume billing as usual. Until deductibles are met, our payments are delayed. To make matters more complicated, for clients who are QMB Medicaid (very low-income), the Federal government forbids us from billing or collecting deductibles/co-pays from them.

We have surveyed our therapists multiple times over the years and have asked for their help and input regarding the best way to manage the deductibles each year. We have based the options (see below) on our own therapist’s input. The majority of therapists elect Option #1 and therapists are paid for sessions after deductibles are met. Please review and select the best option for you.

There is no disruption in pay until the end of February (when you are paid for January sessions), giving us and you time to plan. Hopefully the majority of deductibles will be met early, resulting in minimal disruption. Most clients tend to meet their deductibles in January or February, but some not until later. We run deductible amounts weekly and stay up to date on what can be billed and when.

Please review the following options, choose 1 option and sign below.

We will apply your choice for every year moving forward, so you don’t have to receive this election every year. However, if you wish to change your option, you are more than willing to do that at any time.

Bill and Hold: Blue Moon will bill only the clients who have met their deductibles (and those who have supplemental plans that cover deductibles) and wait to bill others until deductible is met.

Have clients Pay: You choose for us to bill your client and have them pay Blue Moon the deductible via check or credit card and you will be paid your normal fee. You may have to discuss with them the deductible issue and payment.

Waive Your Reimbursement: You choose to bill your client session with any existing deductible due and waive any amount due to you. If the amount owed is $200 then the First 2 sessions will be paid towards the deductible and NOT to Blue Moon or yourself.

Your choice is not a final decision. We can revisit your specific position as the year progresses and make new or different decisions at that time. The main purpose of this is to have you be aware and acknowledge the upcoming deductible requirement and plan accordingly. If you have questions or want to discuss further, please contact Ben Smith at (855) 241-7160.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Draw Signature
Type In Signature

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signed by Melanie Donohue
Signed On: December 29, 2023

Timestamp

Audit

December 30, 2020 2:23 pm PDT

Independent Contractor Agreement - Schedule C (WY) Uploaded by Melanie Donohue - new@bluemoonseniorcounseling.com IP 47.152.84.216