Medical Billing Forum
Billing => Billing => : CarnationMB March 17, 2013, 09:54:41 PM
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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?
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Many plans do not cover marriage therapy, so billing for the individual sessions but not the marriage therapy is correct as long as the individual is being treated for a covered diagnosis. If you are in - network you need to look at the actual contract because some will only allow you to collect up to the "allowed/contracted" amount for that service (CPT) even if the session is not covered because it's the diagnosis and reason for the service that is non covered. Some contracts will allow you to collect your full billed fee for the non covered service/dx. You must look at the individual contract for that info. We have had patients request we bill it anyway so we do sometimes.
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Thank you so much for your reply Linda!