Payments > Patient Billing

Client wants to be seen for two hours but bill insurance only for one

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barb2512:
And the client is willing to pay for the second hour out of pocket. The client is suicidal and wants to continue to be seen for 2 hour appointments which BCBS of Mass will not pay for. So he wants the first portion of the visit billed to insurance and he wants to pay out of pocket for the second half of the visit. The provider is charging him the allowed amount that  BCBS of Mass allows for the first appointment.

I read on the forum
"""Basically, the legal options are either cash only OR insurance, but no mix of the two.""

Does that apply to this situation?

The counselor does not want to use a crisis code because the client is coming in frequently and we don't think BCBS will consider a regular appointment to be 'crisis' week after week.

The counselor does not want to get an authorization for longer visits because he does not believe the extra payment by the insurance for extended sessions will be worth the paperwork and oversight involved.

Thoughts please.
Barbara

PMRNC:
You had me until this:
--- Quote --- The counselor does not want to get an authorization for longer visits because he does not believe the extra payment by the insurance for extended sessions will be worth the paperwork and oversight involved.
--- End quote ---

That goes with the territory and I think he needs to put in for the authorization.

shanbull:

--- Quote from: PMRNC on October 09, 2014, 04:40:24 PM ---You had me until this:
--- Quote --- The counselor does not want to get an authorization for longer visits because he does not believe the extra payment by the insurance for extended sessions will be worth the paperwork and oversight involved.
--- End quote ---

That goes with the territory and I think he needs to put in for the authorization.

--- End quote ---

Yeah, I agree with Linda. This issue is billing the client for something that would be covered by insurance if prior authorization is granted. The insurance contract almost certainly includes language prohibiting this. If the provider applies for prior authorization and it's denied, then that's a different story.

rdmoore2003:
A suicidal client warrants a crisis......

kristin:
"Paperwork and oversight" is part and parcel of being in the mental health field...so I am kind of taken aback that the counselor doesn't seem to want to do his part, particularly with someone who is suicidal. In my mind, he should be doing everything he CAN to get the longer sessions authorized, so long as there is a need.

Let's pretend he had another client in the same situation, same insurance, but that client didn't offer to pay out of pocket for the second hour, because the client knows insurance will cover a longer session if it is authorized, or that it could very well meet the definition of a crisis. What would the counselor do then?

Tell him to get the authorization, and if insurance won't give one, then he can charge the client out of pocket for a non-covered service.

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