Guest guest Posted August 20, 2006 Report Share Posted August 20, 2006 Has anyone had luck getting their medical insurance provider to pay for the telephone consults? On a autism-insurance group I belong to, someone wrote that they were able to get telephone consults for another Dr paid for using this code (BTW whoever this Dr is charges $300/half hr!!) " procedure code 90887 " this is from a Cignamedicare.com site: Description: Code 90887 is used when the treatment of the patient may require explanations to the family, employers, or other involved persons for their support in the therapy process. This may include reporting of examinations, procedures and other accumulated data. doris land Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 21, 2006 Report Share Posted August 21, 2006 Aetna paid for phone consults for my son for about six months so it's always worth submitting them. They paid automatically at first but then refused even on appeal. We started with BCBS and they paid for the first one but then after that refused all others. Gaylen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 21, 2006 Report Share Posted August 21, 2006 I've heard of at least one person getting their insurance to cover a couple of phone consults after the fact, but it was more of a 'management decision' by that insurance co, and is very rare. The problem w/using the CPT code 90887 - and this is only if my damaged memory is serving me correctly since I don't have a CPT book anymore - is that phone consults actually have their own CPT, so using another is sorta 'mis-coding' and if insurance were to request records the doc could get in trouble. I also believe that 90887 (again, possibly wrong but you'd want to confirm) is more of a miscellaneous code, so fee schedules aren't usually well set up. The other problem is that the allowed payment for those codes are usually nowhere near what the doctor would get for an office visit of the same amount of time spent in an office visit w/the level of care provided in our phone consults. The majority of insurance companies simply do not cover phone consults. Their expectations is that the patient is treated in the office or other outpatient setting, w/few exceptions. The general 'idea' is that medical care can be provided just about anywhere so 'specialty' is relative. Phone consults to an insurance company are considered more of a convenience and outside of the realm of 'medical necessity'. That said, it is always worth trying to talk to your insurance about covering them, but groveling is way more effective than arguing or complaining! And don't really expect that it will happen, either. You can find out exactly which code the office is using, then contact your insurance company to see if they have a fee schedule for that code. And if it is an out-of-network provider (last I heard Dr G was only taking BC?), will they pay any differently (the benefits are usually different). I can assure you that Dr who charged $300/hr was paid nowhere near his fee but rather what someone would be paid for a high-level office visit. HTH- --- Doris and Steve <sjsmith@...> wrote: > Has anyone had luck getting their medical insurance > provider to > pay for the telephone consults? > On a autism-insurance group I belong to, > someone > wrote that they were able to get telephone consults > for another > Dr paid for using this code (BTW whoever this Dr is > charges $300/half hr!!) > > > " procedure code 90887 " > > this is from a Cignamedicare.com site: > Description: Code 90887 is used when the treatment > of the patient may require explanations to the > family, employers, or other involved persons for > their support in the therapy process. This may > include reporting of examinations, procedures and > other accumulated data. > > > doris > land > > > > __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 21, 2006 Report Share Posted August 21, 2006 We get paid for our phone consult. We used to get paid in full for years, but starting Aug. last year due to changes Dr.Goldberg is now out of network provide for our local (MN) BCBS. Still, they pay about two thirds after deductible ($300 a year). This is totaly individual descision that you have to fight for it. You will have better luck if company you are working for is self-insured and just let the BCBS or other provider to do administrative work. We made a case pointing that our phone consultation is prettty much as appointment. We do blood work and communicate by faxes. Try to scary them saying that you will go every time to CA and to pay for real appointment will cost the insurance more. They established special code for us to pay for phone consultation. Let me know if you need more explanation Regina Doris and Steve <sjsmith@...> wrote: Has anyone had luck getting their medical insurance provider to pay for the telephone consults? On a autism-insurance group I belong to, someone wrote that they were able to get telephone consults for another Dr paid for using this code (BTW whoever this Dr is charges $300/half hr!!) " procedure code 90887 " this is from a Cignamedicare.com site: Description: Code 90887 is used when the treatment of the patient may require explanations to the family, employers, or other involved persons for their support in the therapy process. This may include reporting of examinations, procedures and other accumulated data. doris land __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 21, 2006 Report Share Posted August 21, 2006 Good for you! I tried but had no success with this. We are not in a group plan. How far do you live from Dr. Goldberg? For us, living in Illinois, I don't think they would believe us if I said we would make the flight for an in office visit. Barb --- Regina Feferman <help2live@...> wrote: > We get paid for our phone consult. We used to get > paid in full for years, but starting Aug. last year > due to changes Dr.Goldberg is now out of network > provide for our local (MN) BCBS. Still, they pay > about two thirds after deductible ($300 a year). > > This is totaly individual descision that you have > to fight for it. You will have better luck if > company you are working for is self-insured and just > let the BCBS or other provider to do administrative > work. > > We made a case pointing that our phone > consultation is prettty much as appointment. We do > blood work and communicate by faxes. Try to scary > them saying that you will go every time to CA and to > pay for real appointment will cost the insurance > more. > > They established special code for us to pay for > phone consultation. > > Let me know if you need more explanation > > Regina > > Doris and Steve <sjsmith@...> > wrote: > Has anyone had luck getting their medical > insurance provider to > pay for the telephone consults? > On a autism-insurance group I belong to, > someone > wrote that they were able to get telephone consults > for another > Dr paid for using this code (BTW whoever this Dr is > charges $300/half hr!!) > > " procedure code 90887 " > > this is from a Cignamedicare.com site: > Description: Code 90887 is used when the treatment > of the patient may require explanations to the > family, employers, or other involved persons for > their support in the therapy process. This may > include reporting of examinations, procedures and > other accumulated data. > > doris > land > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 22, 2006 Report Share Posted August 22, 2006 Barb, We live even father, in MN. You are right, it was not that easy. This advise was given us by our lawer that we've had for educational purpuses, but it worked for us. Good luck Regina Barb Katsaros <barbkatsaros@...> wrote: Good for you! I tried but had no success with this. We are not in a group plan. How far do you live from Dr. Goldberg? For us, living in Illinois, I don't think they would believe us if I said we would make the flight for an in office visit. Barb --- Regina Feferman <help2live@...> wrote: > We get paid for our phone consult. We used to get > paid in full for years, but starting Aug. last year > due to changes Dr.Goldberg is now out of network > provide for our local (MN) BCBS. Still, they pay > about two thirds after deductible ($300 a year). > > This is totaly individual descision that you have > to fight for it. You will have better luck if > company you are working for is self-insured and just > let the BCBS or other provider to do administrative > work. > > We made a case pointing that our phone > consultation is prettty much as appointment. We do > blood work and communicate by faxes. Try to scary > them saying that you will go every time to CA and to > pay for real appointment will cost the insurance > more. > > They established special code for us to pay for > phone consultation. > > Let me know if you need more explanation > > Regina > > Doris and Steve <sjsmith@...> > wrote: > Has anyone had luck getting their medical > insurance provider to > pay for the telephone consults? > On a autism-insurance group I belong to, > someone > wrote that they were able to get telephone consults > for another > Dr paid for using this code (BTW whoever this Dr is > charges $300/half hr!!) > > " procedure code 90887 " > > this is from a Cignamedicare.com site: > Description: Code 90887 is used when the treatment > of the patient may require explanations to the > family, employers, or other involved persons for > their support in the therapy process. This may > include reporting of examinations, procedures and > other accumulated data. > > doris > land > > > > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 22, 2006 Report Share Posted August 22, 2006 Thanks for the advice, Regina. I might try again, but this is a pretty tough insurance co. to deal with! barb --- Regina Feferman <help2live@...> wrote: > Barb, > > We live even father, in MN. You are right, it was > not that easy. This advise was given us by our lawer > that we've had for educational purpuses, but it > worked for us. > > Good luck > Regina > > Barb Katsaros <barbkatsaros@...> wrote: > Good for you! I tried but had no success > with this. > We are not in a group plan. How far do you live from > Dr. Goldberg? For us, living in Illinois, I don't > think they would believe us if I said we would make > the flight for an in office visit. Barb > > --- Regina Feferman <help2live@...> wrote: > > > We get paid for our phone consult. We used to get > > paid in full for years, but starting Aug. last > year > > due to changes Dr.Goldberg is now out of network > > provide for our local (MN) BCBS. Still, they pay > > about two thirds after deductible ($300 a year). > > > > This is totaly individual descision that you have > > to fight for it. You will have better luck if > > company you are working for is self-insured and > just > > let the BCBS or other provider to do > administrative > > work. > > > > We made a case pointing that our phone > > consultation is prettty much as appointment. We do > > blood work and communicate by faxes. Try to scary > > them saying that you will go every time to CA and > to > > pay for real appointment will cost the insurance > > more. > > > > They established special code for us to pay for > > phone consultation. > > > > Let me know if you need more explanation > > > > Regina > > > > Doris and Steve <sjsmith@...> > > wrote: > > Has anyone had luck getting their medical > > insurance provider to > > pay for the telephone consults? > > On a autism-insurance group I belong to, > > someone > > wrote that they were able to get telephone > consults > > for another > > Dr paid for using this code (BTW whoever this Dr > is > > charges $300/half hr!!) > > > > " procedure code 90887 " > > > > this is from a Cignamedicare.com site: > > Description: Code 90887 is used when the treatment > > of the patient may require explanations to the > > family, employers, or other involved persons for > > their support in the therapy process. This may > > include reporting of examinations, procedures and > > other accumulated data. > > > > doris > > land > > > > > > > > > > > > __________________________________________________ > > Quote Link to comment Share on other sites More sharing options...
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