Insurance double-billing for add-on codes

[clausewitz2]

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In the local private practice psychiatry group, various people are recounting the fresh hell one of the local insurers is subjecting their patients to, namely that they are charging double co-pays for visits that involve psychotherapy add-on codes. That is to say, patients are getting billed, say, $40 for a specialist visit but if a +90833 is added then they get billed an extra $40 as it is "additional services". Some folks have reached out to people they know internally at the insurer and get this reversed, but some are not at all successful in having this corrected, even when the patients file member appeals and are being told that this is all correct.

Has anyone had to deal with this particular brand of f***ery? How did you resolve the situation and how long did it take?

Fingers crossed, none of my patients have had to deal with it, but I don't like the idea of being utterly powerless to do anything about it if/when it happens.

 

[nexus73]

State insurance commissioner report? APA mental health parity group would be interested as well I'm sure.

Do they charge a separate co-pay when a family doctor uses a CPT code after freezing off a wart? Or a dermatologist removes a skin tag? Or ENT does a laryngoscopy? Or do they just do it for things insurance doesn't want to actually pay for?

 

[calvnandhobbs68]

Haven't had this happen yet as far as I know and we definitely have crossover between insurance panels. I get our billing reports every 2 weeks so I should be able to see it if it happens. I do know though that some people's insurance plans may have separate psychotherapy benefits from medical benefits though, so maybe that's part of the issue? Or it's just insurance companies being a pain in the ass.

Insurers try all kinds of stupid ****. PP facebook psych group also had something last year about Aetna, Cigna or BCBS (can't remember which one) automatically downcoding all codes with therapy add on codes to 99213 + 90833. The stink about that died down, so not sure if that got fixed when they complained to the insurance commissioner.