We are a psychiatric office that is out-of-network with Anthem and we have a patient with a State Bluecare POE policy. Strangely, this policy has no OON mental health coverage but reimburses 100% for OON medical. In the past we have gotten paid on 90862 charges but any therapy codes were denied as OON.
In 2013, they are denying our 99213 charges. Any idea why they would have paid 90862(they must have considered it medical) in the past but now deny payment on 99213? We have a few patients with this same situation. Thanks in advance for any advice.