Re: Visits equating to Units

[Guest guest]

Hi,

Have not heard of this but anything is possible with insurances.

First you need to see her benefits policy information and see what it says

in writing. No matter what it says, I would appeal it to the highest level

as this is not the standard and can be argued that way. Because this is not

standard, it could be argued that their practices are deceptive which may

necessitate getting a lawyer involved. You can also check with your state

insurance department/commission and see what they have to say. Generally

they are watchdogs against any insurance deceptive practices as well.

Please keep us informed as this could represent something new we have to be

aware of.

M. Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, Idaho

thowell@...

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From: PTManager [mailto:PTManager ] On Behalf

Of

Sent: Thursday, June 23, 2011 9:17 AM

To: PTManager

Subject: Visits equating to Units

Hello group,

We have a patient who was seen earlier this year for 18 visits with a total

charge of 54 units. Prior to therapy we authorized her coverage and was told

by BCBS-Illinois that she had 36 visits per calendar year of physical

therapy coverage. (She was adamant that we did not exceed her coverage as

money is tight.) Her claims were denied after 12 visits, the explanation

being that she did not have coverage for 36 VISITS, but rather for 36 UNITS.

BCBS has told us, in multiple phone calls, that they equate visits with

units.

This seems absolutely outrageous to me - I have never heard of anyone,

provider or insurance, equating visits with units. Has anyone else had this

experience, and if so, how did you resolve it?

Respectfully,

Christen, PT

Director, Rehabilitation and Occupational Health Services

FHN

Freeport, IL

[Guest guest]

Why is it that PT's always feel like it is 'our fault'. I would bill the

patient and tell her to raise heck with her insurance company. Explain to her

how THEY messed up. The insurance companies listen when the person paying

premium (employer) raises cane, not when the providers do.

Let the patient get a lawyer, call the insurance commission, etc. Granted I

would talk to them about those options, but it's ultimately the patient's

responsibility.

Now, on the other hand, if you have some caveat in your network contract, saying

you can't get paid if you go over 'units' then...oh well. Try to get the

contract changed.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississsippi

Visits equating to Units

Hello group,

We have a patient who was seen earlier this year for 18 visits with a total

charge of 54 units. Prior to therapy we authorized her coverage and was told

by BCBS-Illinois that she had 36 visits per calendar year of physical

therapy coverage. (She was adamant that we did not exceed her coverage as

money is tight.) Her claims were denied after 12 visits, the explanation

being that she did not have coverage for 36 VISITS, but rather for 36 UNITS.

BCBS has told us, in multiple phone calls, that they equate visits with

units.

This seems absolutely outrageous to me - I have never heard of anyone,

provider or insurance, equating visits with units. Has anyone else had this

experience, and if so, how did you resolve it?

Respectfully,

Christen, PT

Director, Rehabilitation and Occupational Health Services

FHN

Freeport, IL

[Guest guest]

I couldn't agree more, Matt. I don't feel this is our fault in any way. We

verified her benefits prior to care as a courtesy. Unfortunately the nature of

healthcare, whether we like it or not, is that patients feel WE are responsible

to know what their insurance coverage is and not exceed it. (They feel no

responsibility whatsoever to check into coverage prior to seeking care.) I

spoke at length with this patient and despite my explanations that we have

absolutely no control over the situation, that the employer has much more

leverage than we, and this is situation is completely unheard of in the therapy

world, she remained angry with us, stating that we were " screwing " her. All she

wanted to hear from me is that we would write off her bill, which we're not

doing. Now she has gotten the employer involved. Maybe we'll see some light

after all.

Christen, PT

Director of Rehabilitation and Occupational Health Services

FHN

Freeport, IL

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

acceleratedptbsl@...

Sent: Thursday, June 30, 2011 5:32 PM

To: PTManager

Subject: Re: Visits equating to Units

Why is it that PT's always feel like it is 'our fault'. I would bill the patient

and tell her to raise heck with her insurance company. Explain to her how THEY

messed up. The insurance companies listen when the person paying premium

(employer) raises cane, not when the providers do.

Let the patient get a lawyer, call the insurance commission, etc. Granted I

would talk to them about those options, but it's ultimately the patient's

responsibility.

Now, on the other hand, if you have some caveat in your network contract, saying

you can't get paid if you go over 'units' then...oh well. Try to get the

contract changed.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississsippi

Visits equating to Units

Hello group,

We have a patient who was seen earlier this year for 18 visits with a total

charge of 54 units. Prior to therapy we authorized her coverage and was told

by BCBS-Illinois that she had 36 visits per calendar year of physical

therapy coverage. (She was adamant that we did not exceed her coverage as

money is tight.) Her claims were denied after 12 visits, the explanation

being that she did not have coverage for 36 VISITS, but rather for 36 UNITS.

BCBS has told us, in multiple phone calls, that they equate visits with

units.

This seems absolutely outrageous to me - I have never heard of anyone,

provider or insurance, equating visits with units. Has anyone else had this

experience, and if so, how did you resolve it?

Respectfully,

Christen, PT

Director, Rehabilitation and Occupational Health Services

FHN

Freeport, IL

[Guest guest]

I couldn't agree more, Matt. I don't feel this is our fault in any way. We

verified her benefits prior to care as a courtesy. Unfortunately the nature of

healthcare, whether we like it or not, is that patients feel WE are responsible

to know what their insurance coverage is and not exceed it. (They feel no

responsibility whatsoever to check into coverage prior to seeking care.) I

spoke at length with this patient and despite my explanations that we have

absolutely no control over the situation, that the employer has much more

leverage than we, and this is situation is completely unheard of in the therapy

world, she remained angry with us, stating that we were " screwing " her. All she

wanted to hear from me is that we would write off her bill, which we're not

doing. Now she has gotten the employer involved. Maybe we'll see some light

after all.

Christen, PT

Director of Rehabilitation and Occupational Health Services

FHN

Freeport, IL

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

acceleratedptbsl@...

Sent: Thursday, June 30, 2011 5:32 PM

To: PTManager

Subject: Re: Visits equating to Units

Why is it that PT's always feel like it is 'our fault'. I would bill the patient

and tell her to raise heck with her insurance company. Explain to her how THEY

messed up. The insurance companies listen when the person paying premium

(employer) raises cane, not when the providers do.

Let the patient get a lawyer, call the insurance commission, etc. Granted I

would talk to them about those options, but it's ultimately the patient's

responsibility.

Now, on the other hand, if you have some caveat in your network contract, saying

you can't get paid if you go over 'units' then...oh well. Try to get the

contract changed.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississsippi

Visits equating to Units

Hello group,

We have a patient who was seen earlier this year for 18 visits with a total

charge of 54 units. Prior to therapy we authorized her coverage and was told

by BCBS-Illinois that she had 36 visits per calendar year of physical

therapy coverage. (She was adamant that we did not exceed her coverage as

money is tight.) Her claims were denied after 12 visits, the explanation

being that she did not have coverage for 36 VISITS, but rather for 36 UNITS.

BCBS has told us, in multiple phone calls, that they equate visits with

units.

This seems absolutely outrageous to me - I have never heard of anyone,

provider or insurance, equating visits with units. Has anyone else had this

experience, and if so, how did you resolve it?

Respectfully,

Christen, PT

Director, Rehabilitation and Occupational Health Services

FHN

Freeport, IL

[Guest guest]

I couldn't agree more, Matt. I don't feel this is our fault in any way. We

verified her benefits prior to care as a courtesy. Unfortunately the nature of

healthcare, whether we like it or not, is that patients feel WE are responsible

to know what their insurance coverage is and not exceed it. (They feel no

responsibility whatsoever to check into coverage prior to seeking care.) I

spoke at length with this patient and despite my explanations that we have

absolutely no control over the situation, that the employer has much more

leverage than we, and this is situation is completely unheard of in the therapy

world, she remained angry with us, stating that we were " screwing " her. All she

wanted to hear from me is that we would write off her bill, which we're not

doing. Now she has gotten the employer involved. Maybe we'll see some light

after all.

Christen, PT

Director of Rehabilitation and Occupational Health Services

FHN

Freeport, IL

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

acceleratedptbsl@...

Sent: Thursday, June 30, 2011 5:32 PM

To: PTManager

Subject: Re: Visits equating to Units

Why is it that PT's always feel like it is 'our fault'. I would bill the patient

and tell her to raise heck with her insurance company. Explain to her how THEY

messed up. The insurance companies listen when the person paying premium

(employer) raises cane, not when the providers do.

Let the patient get a lawyer, call the insurance commission, etc. Granted I

would talk to them about those options, but it's ultimately the patient's

responsibility.

Now, on the other hand, if you have some caveat in your network contract, saying

you can't get paid if you go over 'units' then...oh well. Try to get the

contract changed.

Matt Capo, PT

Accelerated Physical Therapy and Occupational Health, Inc.

Bay St. Louis and Diamondhead, Mississsippi

Visits equating to Units

Hello group,

We have a patient who was seen earlier this year for 18 visits with a total

charge of 54 units. Prior to therapy we authorized her coverage and was told

by BCBS-Illinois that she had 36 visits per calendar year of physical

therapy coverage. (She was adamant that we did not exceed her coverage as

money is tight.) Her claims were denied after 12 visits, the explanation

being that she did not have coverage for 36 VISITS, but rather for 36 UNITS.

BCBS has told us, in multiple phone calls, that they equate visits with

units.

This seems absolutely outrageous to me - I have never heard of anyone,

provider or insurance, equating visits with units. Has anyone else had this

experience, and if so, how did you resolve it?

Respectfully,

Christen, PT

Director, Rehabilitation and Occupational Health Services

FHN

Freeport, IL