Wiki Global maternity

[Kholloway]

The patient was seen an excess of 7+ visits and then the c-section with post partum visits. Has anyone ever had an insurance company deny billing the global with the post partum because her plan will be termed prior to her global post partum completion date?? 6 weeks post partum and her insurance is set to cancel 3 days prior to the full six weeks. UHC is stating that we can bill the global c section due to this discrepancy. I have worked in OBGYN for 7+ years and this has never been an issue. Any insight??

 

[macie.laurel@gmail.com]

UHC Issues

I am having all sorts of trouble with UHC billing global maternity and I am at my wit's end with them. As far as I can tell they are denying global maternity for all sorts of reasons, ie pt didn't have coverage for 9 months prior to delivery, or pt will not have for 6 weeks after delivery. I'm not sure what to do they are driving me crazy!! Please post if you ever find a solution!

 

[Jaklynnlee@gmail.com]

Outside of Global-HELP

I am having a difficult time with out of global coding. I have a pt. that transferred to new Dr./new Facility at 34 weeks. I am not sure if I am supposed to code as a "consult" as requested or go with a standard E/M visit?? How are these typically handled?

Thanks in advance for your help with this!!

 

[Palmtoptiger]

The patient was seen an excess of 7+ visits and then the c-section with post partum visits. Has anyone ever had an insurance company deny billing the global with the post partum because her plan will be termed prior to her global post partum completion date?? 6 weeks post partum and her insurance is set to cancel 3 days prior to the full six weeks. UHC is stating that we can bill the global c section due to this discrepancy. I have worked in OBGYN for 7+ years and this has never been an issue. Any insight??

Hi,

I worked at UHC commercial insurance before. As i can remember, if the patient's insurance termed prior to the completion of the post partum visits, you will need to submit an itemized claim instead of billing the global maternity code.

I can see that it's really frustrating especially that there are only 3 days to complete the post partum period.

I don't know if this helps, but have you talked to one of their reps already?

You may also check the Obstetrical Policy at unitedhealthcareonline.com under policies and guide.

 

[Palmtoptiger]

I am having a difficult time with out of global coding. I have a pt. that transferred to new Dr./new Facility at 34 weeks. I am not sure if I am supposed to code as a "consult" as requested or go with a standard E/M visit?? How are these typically handled?

Thanks in advance for your help with this!!

Hi,

I copied the info below from Obstetrical Policy of UHC Commercial Insurance.

If the patient is treated for antepartum services only, the physician and/or other health care professional should use CPT code 59426 if 7 or more visits are provided, CPT code 59425 if 4-6 visits are provided, or itemize each E/M visit if only providing 1-3 visits.

 

[Faith07]

Kholloway,

I have never seen that either with the insurance trying to deny due to the insurance terming during their 6 week PP. Was the patient already seen for her postpartum visit before the ins was termed? If she was seen before the insurance termed for her postpartum, fight it. Send them the medical records showing that although her insurance was due to term on xx date she was already seen for her PP visit on this date XX date so she was seen during the time she was active send the records.

If she wasn't I don't see anything in the UHC guidelines that indicates if the insurance terms during the postpartum time you cannot bill global tell them to show you the guidelines it states one postpartum visit. UHC is notorious for denying Globals for the every reason but if you have the guidelines you can fight it might take a long time though.

macie.laurel@gmail.com,

Can you give more of an example of why they are denying do to her not having coverage 9 months before delivery, did the patient have prior care before coming to the clinic for pregnancy?