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Substance Abuse Community

Reply: Doctor overcharging for Suboxone Treatment?

That is B.S. insurance Companies do allow billing for Suboxone from intake 1st...

Posted by Outpatienttreatme

That is B.S. insurance Companies do allow billing for Suboxone from intake 1st Appt & each follow up appt. office simply would use code 99203 and diagnosis 305.50 1st visit and 98213-99216 and diagnosis 304.00 for follow up visits. To be sure office could easily call your insurance for Pre-Certification of treatment visits & once approved, office knows they will get paid. Most insurance pays a good rate to office (similar to what you are being charged) for the patients visits. If they won't do that then you have a right (written rule) to ask them to complete their portion of a claim (billing form) either Form 1500 or print out blank claims direct from your insurance co website, and have them keep supply in your chart or bring one to each visit. Ask them to fill in & sign their part if form then you fill in yoUr info. Make sure you sign the line that reads "assignment of benefits to patient" (not doctor or facility). This means any reimbursement (avg. 40-60%) of your visit cost is reimbursed back TO YOU if you paid office in full each visit. Your usually can do this retroactive 90 days too. In beginning insurance did not pay dr claims against suboxone treatment, but they do now for a long time. Call Your insurance to get your visits pre-certified Using procedure & diagnosis codes above 1st if authorized to go out of network and they approve your request you will get most if your visit fee reimbursed ea time as fir med not being covered, it Only means not on your insurance "Formulary" & needs Prior-Authorizatiob call member services tell them you need a prior auth request form faxes to your Dr office under your name for med subixone in dose & maximum qty you expect to get rx'd dr office must submit this request takes less than 5 min via fac or can do over telehone and usually if correct procedure abd diagnosis codes used (see above if apply to you-probably do) also insurance more readily approves suboxone cost coverage if rx'd the Film vs Tablet they will ok covering cost of suboxone film (msybe tab too) ususlly for 1 year (than a renewal) & max30-day Qty of #90. It is a simple procedure and dr office should do for you if they want you ad a patient make sure prior-auth for coverage of med cost is done for actual med, dose & frequency ((request #1) & ALSO for approval request for 30-day QTY (Request #2) both can be requested & approved during same call or fax of Prior-Auth Request to insurance co. Good luck. Send MSG, if you have any ?'sView Thread

Posted byOutpatienttreatme

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