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Medical billing for mental health issues

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bigearl67

Junior Member
I am In Indiana.
My special needs son was seeing a counselor for about six months. The counselor was not too effective so I asked the treating facility for help on the matter. They assigned him another counselor. This was covered under medicade. Medicaid lapsed for several months and I had them bill my insurance company (this while going thru a nasty divorce). I kept getting monthly bills in the mail and discussed this with the attending counselor. She kept telling me she would have them bill the insurance company. Five phone calls over this short time to the office she worked out of got me the response that they would bill/rebill the insurance company.
She was told she could no longer see my son since the bills were not paid. My O.D.D. and A.D.H.D son is suffering from abandonment issues (his mother) and has had a serious relapse due to her not seeing him.
On month four I visited the office and asked why the bills were not forwarded to my insurance company. I was at that point told that the counselor was not licensed in Indiana too bill insurance companies as she is a social worker. Despite numerous conversations with her on this, this fact was never brought up. She even confessed (in a saved email) that she really did not know the billing procedure.

I was also told that when I was calling them their response was to email the other billing office. When I asked them to bill they simple sent an email to someone else.


By this time the bill is at almost 7000 dollars for a little over three months. They suggested I talk with the billing department in the other office. I visited this office and was told that my insurance company had never been billed. I discussed this with one of the billing people and was told the emails were not acted upon.
I have a 6000 dollar behavioral health care deductible which is not met and asked them on sept. 16 to submit these bills to go against that. On the 25th in follow up I was told that they still had not done this. An email last night from the social worker stated that one “test” bill had been sent in and was not paid. There are over forty separate bills.

Over the past month I talked with my insurance company and was told it could be covered under the broader umbrella of behavioral health care and I was able to get the social worker (new), by name, in their covered group. They do need the diagnosis codes to apply it to my deductible.
I am not in collections yet and want to head this off before it goes too far. The problem seems to be the serious lack of communication between the social worker, billing department and the women taking the phone calls.

I feel that they let a huge bill accumulate while leading me to believe it was being covered in part by my insurance company.
I believe this is dishonest but not sure if it’s legal.
Dealing with these people is like spinning in a hamster wheel. Their response is to just pay the bill, which I can not afford..
Can anyone please recommend any proactive steps I should take?
 


single317dad

Senior Member
I don't have enough experience dealing with Medicaid to offer any constructive advice on how to deal with that particular bureaucracy. My mother has worked in a pharmacy for decades and I suppose you can take a little comfort in the fact that you are not the only one who can't seem to figure them out. I don't know if this place can help you or not, but as a new single father who had no idea what to do or where to turn in dealing with various government agencies, these folks were a godsend:

http://www.childrensbureau.org/

And in particular this division:

http://www.childrensbureau.org/what-we-do/community-partners-for-child-safety

The root of your question seems to be whether the provider has any duty to handle the billing for services you received, and if so, whether you bear the responsibility for their failure to do so properly. Generally, the patient (or the guarantor, in your case) will find themselves holding the bag when provider and insurance don't see eye to eye. Medicaid is a little different, in that if you're receiving a product or service that Medicaid covers, then you must use Medicaid for that product or service (not sure if this is federal or just an Indiana thing).

Hopefully this site will prove of some use, at least as a springboard for further research:

http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities.html

Mental health providers who accept Medicaid for children are in a constant state of chaos. The workers are paid so little that of course they are always seeking other opportunities (or are of such poor quality that they are cut loose). The office where I take my son has a Medicaid roster, and the turnover there in the past year is astounding. Nearly every employee has been replaced at least once since we've been assigned to that office, including his LSS who he had become quite attached to.

In the end, remember that the squeaky wheel gets the grease. You should call all these places daily or multiple times per day until you get the answer you want. If it seems like you're getting the blow-off, it's probably because someone else is being a bigger pain in their rear than you are.
 
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