I'm doing billing for a mental health therapist.
I have been told not to submit claims to insurance that are not going to be covered.
For example: a couple comes in for Marriage Therapy (V61.10) and when doing the insurance coverage, insurance says no V codes are covered.
We bill insurance for the clients individual sessions (90834) with a diagnose 309.0 (just an example, not always this code). But we do not send claims for the 90847 sessions.
Is this correct? Is it different for InNetwork and Out Of Network?
If we are in network and sessions are not covered, does the insured client pay our cash rate or do they pay the insurance negotiated allowed amount?