Author Topic: Question in regards to authorizations from insurance...  (Read 2847 times)

kwardbilling

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Question in regards to authorizations from insurance...
« on: January 23, 2010, 01:23:56 PM »
Hi, I have a silly question.  When you have a patient, i.e. that is on bcbs and they don't need prior approval for their initial 12 visits, and then need prior authorization for further visits, once you get the authorization , say for 15 visits, do you have to count the initial 12 toward that authorization?  I didn't believe you did, but then ran out of authorizations on one patient because they claimed I had to use them toward the initial 12?  Does that make sense?

Pay_My_Claims

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Re: Question in regards to authorizations from insurance...
« Reply #1 on: January 23, 2010, 08:59:03 PM »
You should def. ask that with the INS company, but from what you are saying you don't. I have 6 free nutritionist visits with BCBS-member health partners, and any subsequent visits I am subject to my ded/coins/copay. I would feel in sense it works just like that. The 7th visit I would be charged. ON their 13th visit you would need to get auth for that and any others.

kwardbilling

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Re: Question in regards to authorizations from insurance...
« Reply #2 on: January 24, 2010, 02:28:59 PM »
Thanks, that's exactly what I thought...will follow up with insurance co.

NuBiker

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Re: Question in regards to authorizations from insurance...
« Reply #3 on: January 25, 2010, 02:58:56 AM »
What I do in that situation, is about visit #9 of 12, I phone the insurance and ask what to do.
Sometimes, they will give the Auth right over the phone, other times, they want the Doc to fill out a P.A.R. (Patient Authorization Request) and fax it in.
I try to do it ahead of time because some insurances won't back date Auths.

kwardbilling

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Re: Question in regards to authorizations from insurance...
« Reply #4 on: January 25, 2010, 11:00:30 AM »
Thanks, I usually on session #9 remind the psychologist that they need to make sure they have an authorization in place.....

Medical Billing Forum

Re: Question in regards to authorizations from insurance...
« Reply #4 on: January 25, 2010, 11:00:30 AM »

PMRNC

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Re: Question in regards to authorizations from insurance...
« Reply #5 on: January 26, 2010, 03:02:38 PM »
Most carriers will authorize 1 90801 and then XX individual therapies and will actually tell you what codes are being authorized along with a printed copy of the auth. Of course this is all going to be changing with the new parity laws that took effect 1/1/2010  Those groups with 50+ lives who opt to continue mental health benefits will fall under parity in which MH visits have to be processed and considered as all other illness (no limits or cut coinsurance) and then there are plans that will opt not to pick up the mental health benefits upon renewal at all.
Linda Walker
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Medical Billing Forum

Re: Question in regards to authorizations from insurance...
« Reply #5 on: January 26, 2010, 03:02:38 PM »