A Helpful Tip

I am still here at Empowered Grace.  I’m doing a different sort of advocacy, and it takes time.  I’ll say this–all caregivers should go to therapy.  It is so important to take the time to invest in self-advocacy.  That’s where I am.

That is, however, not what I’ve come to report.  I learned something.  Something really important about insurance and billing, and I want to pass it on.  Why? It’s that important.

I’ve written at length about the benefits of getting neuropsychological testing.  Many providers work in an office setting.  If this is the case for your provider, then this doesn’t apply to you.  If you, however, go to a hospital as we did, then you will want to pay attention.  When you go to a hospital, you pay the physician fees and the facilities fees.  In other words, you pay to be in the building.  When Grace and Eadaoin had their neuropsychological testing done, they were in a hospital setting.  We essentially paid rent on the room in which the testing was done; that’s the facilities fees.  I had no idea that such a fee existed.  I feel a bit stupid in retrospect.

So, when the provider’s fees arrived in the form of a statement, I was able to observe on the forms that the hospital had submitted the fees to the insurance company for payment.  This was good.  There was a pre-authorization in place.  The fees would be paid.  Hooray! When the facilities fees arrived at my house in the form of a separate statement I was very confused.  I had no idea what the statement even was.  Hadn’t they already submitted these charges for payment?

So, I called the hospital, and a woman explained to me the difference between provider fees and facilities fees.  I told her to just submit the facilities fees to our insurance company, and this is when it gets really weird.  She refused.  The hospital will not submit facilities fees to any sort of behavioral health insurance company as it does not consider behavior health insurance “real” insurance.

Pardon my language, but you’ve gotta be fucking kidding me.

Behavior health insurance like United Behavioral Health is not “real” insurance? No.  Why? Because what it covers are not real physical sicknesses.

Once again, you’ve gotta be fucking kidding me.

This is the perpetuation of stigma in providing mental health care in the health care community at its best, or worst as the case may be.

I argued until the woman either wanted to cry or wanted to have me assassinated.  Either way, she wouldn’t budge.  She offered to set up a payment plan for me so that I could pay off over $1500 in fees that my insurance company should be paying if only they would submit the claims.

“Oh wait, I will submit them myself.”

And that is exactly what I did.  I completely forgot that I could submit a claim myself until my inner toddler spoke up–“Imma do it myself!”  I found a person in the billing department who gave me the billing codes for the neuropsychological testing, and I looked up diagnostic codes for the mental health diagnoses online.  My “fake” insurance company will be paying the claims.  I received the first explanation of benefits (EOB) in the mail yesterday.

So, should this happen to you, always remember that you can submit claims yourself! It took me a while to figure that out what with my reptilian brain running the show for a bit.  Also, if you go to a hospital for neuropsychological testing, you will be charged facilities fees.  Prepare to see two sets of charges.  Your “fake” insurance company (if your health insurance farms out your mental health care to a behavior health insurance company) should pay for both.

I want to write a letter.  I really want to write a letter to the hospital about this.  Someone stop me.