Wiki LPC Co pay

[GMMTimmons]

Is an LPC considered a Specialist?
Does he collect the patient's Specialist Co pay amount or regular office visit Co pay? We are seeing the insurance companies processing some as regular office visits. Not sure which is correct and whether we should be having them reprocess accordingly. Any help or links to the subject matter would be greatly appreciated. Thanks in advance.

 

[csperoni]

I believe this would be up to the specific insurance company and how the provider is credentialed with them.

 

[sls314]

Is an LPC considered a Specialist?
Does he collect the patient's Specialist Co pay amount or regular office visit Co pay? We are seeing the insurance companies processing some as regular office visits. Not sure which is correct and whether we should be having them reprocess accordingly. Any help or links to the subject matter would be greatly appreciated. Thanks in advance.

It's not really either.

The patient's benefit plan should spell out what the mental health copay is. If you're verifying benefits before treating the patient, you should know what to collect.

Some benefit plans might happen to set the mental health copay as the same amount as an office visit, but it doesn't necessarily have to be. It could be an entirely different amount that doesn't match the physician office visit or specialist copay.

 

[KenSchae]

For the most part, our LPC doesn't have a copay associated with any of the plans. There is one exception, where the EOBs that came back indicated that a patient has a $50.00 copay.

We have started calling on all Behavioral Health services before the appointment to verify coverage and copays because many plans either require PAs or only allow a limited number of BH visits. The limited number of visits is the issue that keeps grabbing us more than the copay issue.

 

[GMMTimmons]

It's not really either.

The patient's benefit plan should spell out what the mental health copay is. If you're verifying benefits before treating the patient, you should know what to collect.

Some benefit plans might happen to set the mental health copay as the same amount as an office visit, but it doesn't necessarily have to be. It could be an entirely different amount that doesn't match the physician office visit or specialist copay.

Our client is new to taking insurance and I have a feeling does not call to verify benefits. I'll take a look at some of these patient's plans for him and advise him. Thanks for the info.

 

[GMMTimmons]

For the most part, our LPC doesn't have a copay associated with any of the plans. There is one exception, where the EOBs that came back indicated that a patient has a $50.00 copay.

We have started calling on all Behavioral Health services before the appointment to verify coverage and copays because many plans either require PAs or only allow a limited number of BH visits. The limited number of visits is the issue that keeps grabbing us more than the copay issue.

Thank you!