All participating CMM members have agreed to a Personal Responsibility pursuant to their program level. Please refer the following chart for details.
Example A: What is my Personal Responsibility if I went to see my doctor for shingles in April of 2015 (Incident 1); received medical treatment for a broken leg in August of 2015 (Incident 2); and appendicitis surgery in February of 2016 (Incident 3)?
(1) Gold Plus Program Members
In accordance with your treatment date from the medical provider, your Personal Responsibility for both Incidents 1 & 2 would be a total of $500 for the 2015 calendar year; another $500 Personal Responsibility applies for the medical treatment/service in 2016 (Incident 3).
(2) Gold, Silver, & Bronze Program Members
All
treatments in the example above are considered a separate incident.
If, as a result of the member’s own efforts the qualifying itemized bills reflect discounts or reductions (Self-Discount) from the doctor(s), hospital or any other provider, the reduction amount will be applied towards your Personal Responsibility. Reductions such as Medicare, state assistance, hospital charity care are considered a “Self-Discount”.
In addition, no more than 90 days must lapse between hospital visits or related treatments/tests for bills to be shared. A lapse greater than 90 days between visits or related treatments/tests for the same incident will be subject to Personal Responsibility.