March 21, 2013
Dear Valued Patient,
On January 1, 2013 the American Medical Association put into effect extensive modifications to behavioral health coding and billing in an effort to accurately and comprehensively capture the procedures that take place during a visit. Since January, we have been working diligently to absorb these changes and understand the impact on our patients. We have waited to brief you until we fully understood how insurance companies would handle these changes. Now that we have a better understanding, we can brief you on these modifications and how they may impact you:
1. A new code category called “therapy add-on codes” has been established. These codes are designed to be used by our prescribing clinicians when they spend ample session time discussing prognosis, test results, compliance/adherence, patient education, risk reduction, and instructions. If you receive any of these services in addition to medication management, this may result in two codes being billed for that session. This type of ‘itemized coding’ has long been the status quo in other areas of medicine. For example, if you present to your family doctor with complaints of an earache and blurred vision, this would likely result in the billing of two different procedure codes—namely, an ear exam and an eye exam.
2. Most visits with our prescribing clinicians are considered to fall under your medical benefits, not your mental health benefits. For these “medication evaluation and management” visits, you will most likely be subject to your medical copay, which can be different than your mental health copay. If you have a medical deductible, you will be responsible for payment of your insurance plan’s approved amount for each session until this deductible has been met.
3. Any therapy visits that you have will be subject to your mental health copay and mental health deductible.
4. Consequently, if you undergo medication management and therapy at RCBM, you may have to pay towards two separate deductibles simultaneously (depending on your specific insurance plan). Although we recognize that this may be frustrating for you, this is dictated by your insurance plan. As providers on your insurance panel, we have a contractual obligation to collect whatever your plan deems to be “patient responsibility,” including applicable deductibles and copays.
5. In the event that you have a medication management visit and a therapy add-on code is applicable, you may be responsible for both your medical copay and your mental health copay in the same visit.
6. Our front office staff is not always aware of how a session will be coded upon your checkout. In these situations, they will collect one co-pay and the other may show up on your next billing statement.
We recognize that these changes are complicated. We are doing our best to minimize the stress to our patients by verifying your medical benefits as well as your mental health benefits with your insurance company whenever possible. Of course, it is always helpful if you are also aware of your benefits. Our billing staff and front office staff are happy to answer any questions you may have. For specific questions about your billing statement or payment plans, please contact our biller, Brenda, at: (248) 851-0526. If you have questions about your visits at RCBM, please contact Ali at: (248) 608-8800.
Jaime Saal, MA, LPC
Joel L. Young, MD
What insurance plans do we accept at RCBM?
Not all RCBM clinicians participate with the same insurance companies. If you have any questions about whether an RCBM clinician is on a specific insurance panel, please contact our front office, as we are happy to help in any way we can. You may also contact our biller, Brenda, at: (248) 851-0526.
Please be aware, however, that we cannot speak for insurance companies or predict their behavior, nor are we responsible for their decisions. For this reason, it is the responsibility of the patient to call their insurance company before they come in for their first visit. During this phone call, the patient should verify their outpatient mental health benefits as well as whether or not their specific provider is in-network for their insurance plan.
Most RCBM clinicians participate with:
Some RCBM clinicians participate with:
At RCBM, we do NOT participate with:
RCBM is currently involved in clinical trials on the following research topics: