Monday, May 07, 2012

Two Different United Health Care Clients, for Same CPT Code, Paid at Vastly Different Rates

There are two clients of mine who both have United Health Care (POB 1459 Route MN 010-S155 Minneapolis, MN 55440-1459).  For one of them, for the Health & Behavior CPT Code 96152, I am paid appropriately.  For the other client, same code, I am paid nothing.  The invoice information comes on the same piece of paper indicating such.

The 'excuse' for the non-paid one is stated to be a problem/ error code with the client having been "self directed out of network" which makes no sense as this company defines itself as being a Medicare advantage company (pretend Medicare, with 3x the administrative costs, which the tax payers are picking up less and less).

As I stated in an earlier post, I have been advised by my biller to contact the NC Insurance Commissioner. I am waiting to see if this company can clear this up prior to doing this.

After I waited on the phone over an hour about a week ago, trying to get this resolved, I was informed that my biller needed to bill on the 'behavioral health' side of things rather than 'the medical side' of things (whatever this means...I have no idea and they could not tell me....the Health & Behavior codes, series 96152, are billed at the medical rate of 80%----if that is what they mean----rather than the completely unjustified mental health rate of 50%).  But then that is not always so as associated with outpatient mental health care as evidenced by TRICARE's billing structure.

You'd have to have a library to keep up with all of this.

Please, someone: give us a universal provider so we don't spend time on this.


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