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Newest Member: Tortex

Off Topic :
My Dr is billing some appts as behavioral/mental health

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 annanew (original poster member #43693) posted at 2:18 AM on Tuesday, June 21st, 2022

Is it common and accepted practice for a doctor to bill some appointments as behavioral health (separate insurance) when

(1) that was not the patient’s stated purpose of the visit (for example - someone books an appt for fatigue and doctor bills appt as mental health)
(2) patient was not informed

Just mainly curious how unusual this is. My doctor dislikes me and has been very dismissive, not even wanting to review test results from other specialists like my allergist, because she decided long ago there’s nothing wrong with me. I probably need a new Dr but I did value her guidance earlier in the relationship. I don’t know what I did to annoy her. I saw her 1x per year for 4 years and then I had some problems and probably went 5x in one year.

Single mom to a sweet girl.

posts: 2475   ·   registered: Jun. 11th, 2014   ·   location: California
id 8741151
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tushnurse ( member #21101) posted at 1:39 PM on Tuesday, June 21st, 2022

Often if you are seen and give them an Oh by the way they will code it differently especially if it changes the level of visit to a higher level of reimbursement.
Also if they are meeting quality metrics and doing a depression survey, or something like that it will be included in the billing for counting the quality metric.

That said you absolutely need a new PCP. Start looking now on average to get in to see a new Dr is a wait of at least 3 months. If you don't feel your Dr is listening though that's not cool.

You need to find a new one. Or a NP- hear me out on this. NP's are coming fromm a different area of focus, and philosophy, a physician is trained to treat conditions. NP's are trained to treat/care for the person. There is a big difference in how you are treated, and visits tend to be longer, and you will be heard (for the most part).

Me: FBS
Him: FWS
Kids: 22 & 25
Married for 30 years now, was 16 at the time.
D-Day Sept 26 2008
R'd in about 2 years. Old Vet now.

posts: 19412   ·   registered: Oct. 1st, 2008   ·   location: St. Louis
id 8741203
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 annanew (original poster member #43693) posted at 7:12 PM on Tuesday, June 21st, 2022

Thanks tushnurse. There was no depression survey or anything like that. I went in for fatigue and cognitive difficulties, and was wanting to keep her in the loop and get her opinion as part of my care team on the food allergies and on the approach that a complex diseases doctor recommended for non-anemic iron deficiency and some minor hormone deficiencies. I did not go in there to discuss mental/behavioral, I suspect she had pre-decided that my problem was something of that nature. That said, it's all connected from my point of view so I would not necessarily have minded it... but from her point of view I know she does NOT think it's all connected, so I feel like this was just another part of the dismissiveness. I don't know why I care, I guess I just wanted a push in the direction of firing her.

Sounds like it's not uncommon but at the same time I should still fire her.

I have had a few great experiences with NPs, and unfortunately one awful one. But you are absolutely right, they can be great and much more communicative. I will look at the entire care team when selecting and select for NP as well as MD.

:)

Single mom to a sweet girl.

posts: 2475   ·   registered: Jun. 11th, 2014   ·   location: California
id 8741264
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zebra25 ( member #29431) posted at 8:16 PM on Tuesday, June 21st, 2022

Is it possible it was a coding mistake? I have had that happen.

I'm not saying that should change your mind about finding a new provider. I'm just throwing that out there as a possible explanation.

"Don't let anyone who hasn't been in your shoes tell you how to tie your laces."

D-day April 2010

posts: 2863   ·   registered: Aug. 25th, 2010
id 8741280
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 annanew (original poster member #43693) posted at 9:16 PM on Tuesday, June 21st, 2022

Thanks Zebra.

I guess I will just ask them what gives. In more polite terms :)

Single mom to a sweet girl.

posts: 2475   ·   registered: Jun. 11th, 2014   ·   location: California
id 8741291
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leafields ( member #63517) posted at 9:37 PM on Tuesday, June 21st, 2022

You can also call your insurance and ask that they review the chart notes because you're not sure it's coded correctly, or explain the situation below.

Generally, they shouldn't be using the psychotherapy codes. Mainly because with psychotherapy, there's a treatment plan and you are doing therapy. If you're discussing treatment options with your doctor, that isn't psychotherapy.

BW M 34years, Dday 1: March 2018, Dday 2: August 2019, D final 2/25/21

posts: 1233   ·   registered: Apr. 21st, 2018   ·   location: Washington State
id 8741296
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tushnurse ( member #21101) posted at 11:31 PM on Tuesday, June 21st, 2022

Yup it could be fat finger mis code too.
But still get a new provider. Is your complex disease physician willing to run the show? If so and your insurance agrees I would do that.

Me: FBS
Him: FWS
Kids: 22 & 25
Married for 30 years now, was 16 at the time.
D-Day Sept 26 2008
R'd in about 2 years. Old Vet now.

posts: 19412   ·   registered: Oct. 1st, 2008   ·   location: St. Louis
id 8741310
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