Question re: billing codes for mental health visits

I'm trying to get reimbursed by Blue Shield of California for visits with a psychiatric nurse practitioner, who is out-of-network and provided me with a superbill. The initial visit was billed as 99205 and 99417, and subsequent visits billed as 99215 and 90836.

For my specific plan, out-of-network mental health office visits (including "Physician visits") are reimbursed at 50% and not subject to my deductible, as opposed to medical specialist visits (non-mental health) which ARE subject to deductible.

Blue Shield is only counting the 90836 portion as a mental health visit, and all the other codes they are counting as a regular (non-mental health) specialist visit, and applying to my deductible rather than reimbursing me at 50%. When I appealed, they stood by their decision and said it's because of the codes my provider used, implying that those codes are only for medical specialist services and not for mental health services. They refused to tell me which codes would be considered mental health codes.

Does this reasoning sound legit, or are they just trying to get out of reimbursing me? Are there perhaps other codes my provider could have used for the same services that would be treated as mental health codes? From what I can tell based on the Blue Shield website and my plan documents, psychiatrists are considered mental health providers. I'm having trouble wrapping my head around a single visit (using only mental health-related diagnostic codes) being considered half mental health and half not.

submitted by /u/oscarwildeflower
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