Guest guest Posted June 23, 2011 Report Share Posted June 23, 2011 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 Quote Link to comment Share on other sites More sharing options...
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