Wiki mental health billing issue

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KATHY WILHELMSEN

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Can Ins. be billed for Court Ordered Therapy-help ASAP

can court ordered group counseling be billed to TriCare Ins. or any Ins. for that matter?
 
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When we asked our payers that question the answer we got was "as long as it meets medical necessity. But just because it's court ordered doesn't mean it's medically necessary." Hope that helps you, it's still a touchy subject here.
 
They are billing one felon's Ins. the full fee of $150.00 and the rest whom have no Ins. $25.00 cash? Just feels wrong but I cannot find anything on it. Do you know anyone who can help that you can refer me to? This is sex offender Group Counseling. I would call Tri Care and ask but do not want to get anyone in trouble until I know for sure.
 
KATHY BALLINGER said:
They are billing one felon's Ins. the full fee of $150.00 and the rest whom have no Ins. $25.00 cash? Just feels wrong but I cannot find anything on it. Do you know anyone who can help that you can refer me to? This is sex offender Group Counseling. I would call Tri Care and ask but do not want to get anyone in trouble until I know for sure.
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That is unethical. Not illegal I dont think but for sure unethical. Should bill the same to everyone/payor.
 
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You can call TriCare and ask a general question if group therapy is covered if it is court orderd... We haven't seen many court orderd therapy for Mental health, but more for Substance Abuse and some insurances will cover if court ordered and others will not..

For the fees, everyone should be billed the same base rate - unless they have applied and been granted some sort of reduced fee based on income/family size - but each would need to apply and qualify, we then make them sign an agreement that they have to make their payment at each visit in full or risk the possibility of loosing their reduced fee and they are allowed X amount of visits to start and then based on each case after that the clinician will discuss w/the office manager on whether or not to extend the visit limit based on clinical/financial needs.
 
$25 cash

As an FQHC facility, we may bill all accounts $150 for the service. However, based on indigent status of the client, they may be liable for as little as $25 for that service.
 
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