A community of 30,000 US Transcriptionist serving Medical Transcription Industry
Personal beef with insurance company!!!
Posted: Mar 12, 2010
We have BC of Oregon. Just found out while making an appt with a psychologist for my son that they will allow typically up to 20 visits a year for mental health, and they count ANYTHING that has a "mental health" type of dx, including if the PCP sees my son for a sore throat and just mentions his depression, and the PCP throws a DX code for depression, that will count against the 20 visits, even if the PCP only responded with "you should talk to Dr. so-and-so about this" and offhandedly uses this code. And I worked with doctors long enough to know that they do this ALL of the time. Also, they can even count new prescriptions, as long as the dx is included, as a mental health visit and count it against your 20 visits!!!!
Okay, now I am pissed! I have a kid with multiple diagnoses, most of which are neurological in origin but considered mental health by insurance companies. He NEEDS every one of those 20 visits just to try and keep him from commiting suicide, let along meds and counseling!
Come on, health care reform!!!!
;
talk to the pcp's office about their coding! - cj
[ In Reply To ..]Outpatient coding should only include the conditions treated in any given visit so if the pcp isn't actually addressing the depression at the visit, they should not be coding it. it's in the official coding guidelines. Let the know you know that and tell them they are doing it WRONG. If you need a reference to the guidelines, let me know!
Unfortunately, I think that health care reform will only... - Kendra
[ In Reply To ..]stand to make this type of thing worse. I have TriCare, which is about as close to government healthcare as one can get. I have a mole on my back that my PCM thinks is cancerous and got a referral to a dermatologist, who will not take my insurance even though he is on the list of preferred providers, so I was then responsible for finding my own dermatologist, at least 1 hour from my house and calling to make sure that he does actually take TriCare. He did not mention, however, that he has no available appointments until September, so I doubt anything run by the government will be any better.
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