Outpatient Mental Health vs Mental Health Office Visit?
I was wondering what is the difference between an outpatient mental health visit and a mental health office visit?
Context: I have United Healthcare Silver-D Advantage Saver and am currently seeing a PA supervised by a Psychiatrist for medication management twice per month and now once per month. Under my SBC, I expected these visits to be $40 since that is the co-pay for mental health out-patient services. In the limitations/exceptions/other important information section, it does list that a $100 co-pay would be applicable for partial hospitalization or intensive outpatient programs. This differs slightly from the myUHC website were it separates it by Mental Health Office Visit as a $40 co-pay and Outpatient Mental Health $100 co-pay. Additionally, my specialist co-pay is $40.
Claims: After switching to UHC and getting some claims processed, I saw I was being charged a $100 copay for these basic visits billed under 99214 and 90833 (debatable because I'm already seeing a therapist separately and I wouldn't count the questions as psychotherapy). Both of the claims were billed to the supervising Psychiatrist, not the PA, which I've never seen before. Previously with my BCBS PPO plan, they would be $0 if done virtually and $20 in-person. After seeing this, I called UHC and they said they'd reprocess the claim.
My question is: Why/how is my Psychiatrist billing for an Outpatient Mental Health visit when all I'm doing is simply video-chatting about my day and having my medication management through them? This doesn't make a whole lot of sense to me and I tried digging on this subreddit for a clearer answer but I'm not finding much. On top of that, I haven't had a great experience with this office either since they kept charging me co-pays for my telehealth visits under my BCBS even though I didn't owe one… and then after inquiring about a refund for a month – two months by now, I haven't gotten much of an answer.
submitted by /u/SensitiveVariety
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