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Thread: Billing Medically Necessary Contact Lenses

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    Billing Medically Necessary Contact Lenses

    Can anyone give me some advice on billing medically necessary contact lenses to medical insurances? We bill 92310 with icd-9 371.61 and keep getting denied. When I call the insurance company they keep telling me vision care is not covered. I can't seem to get through to them that this is a medical condition and NOT routine vision. :hammer:

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    We do a hand full of Medically Necessary Contacts a month but we do it through their vision insurance. There are guidelines to this like anybody over -10.00 or has over -3.00 cyl or we can't get 20/20 out of glasses..........

    Most of the time the insurance gives the pt a bigger benefit towards contacts and they pay us a lot more as well. You have to get approval from the insurance first.

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    Thank you. We usually use there vision insurance also, but in a few cases these patients either have only a discount plan or no vision plan at all. It is very frustrating talking to lazy ins. people who are just reading out of a book and really have no clue at all. It is like they are trained not to listen to what you are trying to tell them.

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    I have never had good luck trying to bill Medical insurance carriers for Medically necessary CLs. In theory they should pay, but they will fight you tooth and nail until you drop dead. On the other hand, I have done well with this when patients have a vision plan that specifically covers it.

    So I would not promise anybody with medical insurance that their CLs will be paid for. They should be made to sign agreement that if their insurance doesn't pay, they need to.

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    Have you tried: "You need this if you want to see well. It will cost you this much? How do you want to take care of the bill?"
    Why worry yourself to death to get the patient a hand out?

    Chip

    Just because it's medically necessary doesn't actually mean that someone else has to provide it for you. Unless one is a democrat of course.
    Last edited by chip anderson; 06-24-2011 at 05:48 PM. Reason: Wanted to.

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    It's tough to get paid... . Many insurance companies won't pay, but the one's that do don't often use standard billing on these.
    One, always get it pre-approved. Write that person's name down.
    2, find out what modifiers they need, the modifiers are key, do they need L and R eyes on seperate lines? sometimes you have to post each eye seperately
    3, find out what diagnosis they will provide medically necessary contacts. Most insurance companies won't pay based on power alone, there needs to be a pathology tied to it such as Kerataconus. Its hit or miss which ins companies pay on which pathologies.

    Always inform the patient that its there responsibility in the long run to get the insurance to pay, not yours. I have had patients go ballistic to their insurance and suddenly a claim is paid. Let them do the work after you have done all you can. I always explained to the patient "Although we are a provider for your insurance, the real contract of claim is between you and your insurance company, we are only a secondary party to agreement that exists between you and your insurance."
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    Bad address email on file vivacia's Avatar
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    Angry

    Quote Originally Posted by chip anderson View Post
    Have you tried: "You need this if you want to see well. It will cost you this much? How do you want to take care of the bill?"
    Why worry yourself to death to get the patient a hand out?

    Chip

    Just because it's medically necessary doesn't actually mean that someone else has to provide it for you. Unless one is a democrat of course.
    Better a Democrat who cares about the welfare of others instead of a stingy, greedy uncaring republican :)

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    Bad address email on file vivacia's Avatar
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    92310 is a vision code, 92311 was the code for medically necessary contacts.

    Contact are medically necessary if the patient has kerataconus or has aphakia. The correct code to use as of 1/1/12 is 92702, NOT 92311 I have filed these type of claims sucessfully with our patient's medical insurance many times.

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    Be very carefull with what you use and bill for though. The other day I got paid $93.00 for a lens that cost me $95.00. And I didn't get paid for a half dozen I used until I came up with this little jewel that worked.
    And there are a few other medical indications beside cones and aphakia. Lots of post corneal transplant patients and others with scarred up irregular eyes (some a result of refractive surgery) can't see with anything other than a rigid contact.

    Chip

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    Our contact fitter here has a form from the kerataconus foundation that he sends out with every insurance request for those types of contacts that breaks down why these aren't just cosmetic contacts and are in fact the insurance's responsibility. I can fax one to you if you want, just pm me your fax number. It seems to help in getting the claims paid, because most insurance companies don't hear "medically necessary" they just hear "contacts."
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    Quote Originally Posted by vivacia View Post
    92310 is a vision code, 92311 was the code for medically necessary contacts.

    Contact are medically necessary if the patient has kerataconus or has aphakia. The correct code to use as of 1/1/12 is 92702, NOT 92311 I have filed these type of claims sucessfully with our patient's medical insurance many times.
    The code is: 92072. If you bill it as 702 you'll get blank stares from the ins co.

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    Bad address email on file vivacia's Avatar
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    92702

    Quote Originally Posted by Uilleann View Post
    The code is: 92072. If you bill it as 702 you'll get blank stares from the ins co.
    I've only done it with the new code with Medicare or BCBS Florida. I sure wish the insurance companies would make it a little easier to file these types of claims.

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