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Question in regards to authorizations from insurance...

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kwardbilling:
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:
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:
Thanks, that's exactly what I thought...will follow up with insurance co.

NuBiker:
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:
Thanks, I usually on session #9 remind the psychologist that they need to make sure they have an authorization in place.....

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