Previously I wrote about our thinking in being non-par providers of vision therapy services. When I first began addressing this years ago, I was somewhat of a Lone Ranger. Progressively through the years more colleagues have begun to share my philosophy of maintaining the primary relationship with the patient rather than with the insurance carrier. Let me show you an example of how we advocate for the patient being reimbursed to whatever extent they are entitled by their carrier.
The nice thing about being a non-par provider is that we can serve as a stronger advocate for the patient than if were were in the system. We don’t have to worry about getting our wrist slapped for making waves. Horizon Blue Cross/Blue Shield happens to be among the better carriers regarding VT reimbursement to the patient. While HIPPA privacy prevents me from revealing our patient’s name, I’m delighted to share the name of Stanley Harris, M.D. with you. I’m not sure who he is, or where he’s located, but as the Medical Director for Horizon BC/BS and a specialist in Pediatrics Dr. Harris gets it. There are several key features to note:
1)As out-of-network providers, our fee for a 30 minute block of orthoptic VT (92065) falls within the usual and customary range for reimbursement.
2) The Medical Director acknowledges that the patient is able to be reimbursed for two consecutive units (60 minutes) of therapy on the same day.
3) Our fee for a sensorimotor progress evaluation (92060-76) falls within the usual and customary range for reimbursement.
Why is this important? Because any time a patient does battle with their carrier over reimbursement, we arm them with whatever ammunition we can. Sample approval letters like the one above, particularly when a patient is covered by the same carrier, are evidence that the treatment is medically necessary, not experimental or educational in nature, and falls within the usual and customary reimbursement range.
– Leonard J. Press, O.D., FCOVD, FAAO