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Wiki Healthcare Reform and Preventative Services

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gatewayclinic

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I have a patient who was seen for a Preventative Medicine 99396 which we used a diagnosis of V70.0. In addition she had preventative labs V70.0 including a Pap V72.31. Insurance was filed with her commercial plan and they responded indicating a personal responsibility due to deductible. Patient and her insurance agent insist we coded incorrectly as patient has full benefits under the healthcare reform bill. Could I get opinions on any additional coding others are using or are the above accurate and should be appealed with her plan? I'm not necessarily concerned about the misc. labs as I am the preventative medicine exam and Pap Smear.

Any suggestions would be appreciated!
 
gatewayclinic said:
I have a patient who was seen for a Preventative Medicine 99396 which we used a diagnosis of V70.0. In addition she had preventative labs V70.0 including a Pap V72.31. Insurance was filed with her commercial plan and they responded indicating a personal responsibility due to deductible. Patient and her insurance agent insist we coded incorrectly as patient has full benefits under the healthcare reform bill. Could I get opinions on any additional coding others are using or are the above accurate and should be appealed with her plan? I'm not necessarily concerned about the misc. labs as I am the preventative medicine exam and Pap Smear.

Any suggestions would be appreciated!
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There is a provision in the new Healthcare law that stipulates patients are not subject to deductibles or copays for preventive services. However, it does not go into effect until the plan renews, so if the patient's plan has not yet renewed for the year, it may not apply yet. Also Health plans that were already in effect on March 23, 2010 are grandfathered in and may not have to comply with the new regulations. That is expected to change in 2014. You billed correctly, the insurance company may not be subject to the new Healthcare Reform Laws...check with the payer.
 
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