Wiki Dept of Transportation cardiac eval - can we bill BCBS insurance

[heartyoga]

I have a dilemma. Patient is a regular patient due for follow up. During his scheduled follow up, he mentioned that he needs a DOT letter clearing him to go to work. Is it wrong to bill his BCBS for this?

We are in a debate on whether to bill patient or submit it to BCBS with codes Z02.4? In which case, not sure if BCBS would pay?

Thanks for your help.

 

[thomas7331]

Many commercial plans have language that specifically excludes coverage of exams and administrative services done for purposes of employment, school, sports, etc. Then there is also the question of what is the appropriate code to bill because standard E&M visit aren't really correct since there is no chief complaint or problem, and it's not really a routine preventive visit either, so if you submit it with one of those codes, it could easily be paid in error and potentially cause a problem. Because of these issues, I don't recommend billing this to insurance - the practices I've worked with will make this a self-pay service and the patient can submit it to their insurance if they desire. My other suggestion would be to contact the patient's insurance first to make sure they provide coverage for the service first, and only submit it if you get confirmation that it is in fact a covered service.

 

[heartyoga]

Thanks!

Thank you for your clarification. I did call BCBS and you are right. They don't cover for DOT physical. It is one of those situation wherein patient comes in for a routine follow up and a "by the way doc..." type of situation.