3 ms·

> Then the insurance takes four fucking months to process your intake session only to come back and say “hey wait, this actually isn’t covered because it’s tech

> Then the insurance takes four fucking months to process your intake session only to come back and say “hey wait, this actually isn’t covered because it’s technically out of network so neither are the 15 sessions that happened afterward”. Now you suddenly owe me 2-3 grand out of pocket and I either have to collect that, probably worsening your mental health by adding a signicant sudden expense, or write it off and basically say goodbye to any renumeration for the 16 hours of work I did. I will ask you to appeal of course. Not a clinician but did (previously) work in software developing claims benefit management software. One of the parts of the recent Surprise Billing reforms was that if a patient "could reasonably believe" that they were in network (and in particular, the prominent example of note being the insurer's website or a provider they use lists the provider as being in-network, because they ostensibly have control or input thereinto), then the insurer was obligated to remunerate the claim as being in-network. i.e. if insurance's directory says "sure, provider X is in-network", they don't get to turn around after you use their service and say "You know what, they're not, so this is uncovered/out-of-network".

hellotheretoday 3y ago
My billing subcontractor has mentioned this as well but in practice it hasn’t worked extremely for us. Sometimes we resubmit and it gets paid, sometimes not. That’s where I often have to get the patient to directly appeal to their insurer. But I’m not sure if the subcontractor is necessarily following necessary procedures. That’s a whole different issue though; I’ve had to change subcontractors twice in my career because after auditing I found they were dropping the ball on stuff like this and just billing clients when there was a path to insurance reimbursement that could be pursued. To insurance companies credit this is an issue at least a part of the time; billing departments and subcontractors that flake on their own work. Far less common but a non zero part of the issue. Thankfully as things transfer to software solutions this becomes less of an issue; I’ve moved a portion of my billing to a software based billing solution rather than a human one and while it still has issues it has less. Sucks for job creation but better for my patients I guess Now I might do another deep billing audit

hellotheretoday 3y ago

My billing subcontractor has mentioned this as well but in practice it hasn’t worked extremely for us. Sometimes we resubmit and it gets paid, sometimes not. That’s where I often have to get the patient to directly appeal to their insurer. But I’m not sure if the subcontractor is necessarily following necessary procedures. That’s a whole different issue though; I’ve had to change subcontractors twice in my career because after auditing I found they were dropping the ball on stuff like this and just billing clients when there was a path to insurance reimbursement that could be pursued. To insurance companies credit this is an issue at least a part of the time; billing departments and subcontractors that flake on their own work. Far less common but a non zero part of the issue. Thankfully as things transfer to software solutions this becomes less of an issue; I’ve moved a portion of my billing to a software based billing solution rather than a human one and while it still has issues it has less. Sucks for job creation but better for my patients I guess Now I might do another deep billing audit