Re: Charging for telephone calls In our small community the overall trend has been to hand over the phone calls to a fee-for-service nurse triage service. Patients call the 800 number, charge $30 to their credit card, and get all the advice they need. We have a written up protocol for meds the nurses may call in, ie nystatin, auralgan, phenergan. If necessary, the nurse calls the doc on call. On average, we get called maybe once or twice a week; no charge but we don't mind because it's so infrequent. The charge also makes parents think twice about calling, thus eliminating those calls about routine-for-the-office-hours issues. Because this is a fairly new concept, the insurance companies didn't have an issue with it. Life is much quieter; we used to get up to 8-10 phone calls an hour! Susan Teaford, MD San Luis Obispo CA -----Original Message----- From: [mailto:] Sent: Sunday, August 08, 2004 9:26 PM To: Subject: PedTalk Digest V1 #1037 PedTalk Digest Monday, August 9 2004 Volume 01 : Number 1037 In this issue: RE: BCBS not paying for ADHD Charging for Telephone Calls Re: Charging for Telephone Calls Re: BCBS not paying for ADHD Re: BCBS not paying for ADHD Insurers and selective imm. coverage Re: BCBS not paying for ADHD L.A. Times Editorial - "Safer Vaccines for Children" See the end of the digest for information about PedTalk-digest. ---------------------------------------------------------------------- Date: Wed, 4 Aug 2004 09:34:34 -0700 (PDT) From: Dave Hoffman <> Subject: RE: BCBS not paying for ADHD I think billing for "something else" is dangerous territory. When I was in med school we had lousy student insurance that didn't cover well visits. At the time I appreciated my daughter's doc coding a 99213 for "Diaper Rash" (which she barely had) on some well visits. But now I feel we should bill for what we do (no more, no less), and leave it up to the parents to gripe to their employer about the inadequate insurance. The flip side of this issue is why insurers will pay "mental health providers," and not primary care providers, for identical services. I was trained in residency to diagnose and treat ADHD, I'm board certified and licensed, and I'm on the provider panel of the insurer. They don't say I can't treat otitis media because I'm not an ENT! Dave Hoffman Howell, MI ------------------------------ Date: Wed, 4 Aug 2004 13:48:49 -0400 (EDT) From: Karen Cookson <> Subject: Charging for Telephone Calls Hi, I am interested to know if any other practices are charging for phone calls made to patients after office hours? If so, can I ask what you are charging? Do any insurance plans currently cover these charges? Thanks for the info. Karen ------------------------------ Date: Wed, 4 Aug 2004 14:29:35 -0400 From: "Brenda Roderick" <> Subject: Re: Charging for Telephone Calls Such a fresh subject in our minds. We approached one of our HMO's about this and they said NO WAY. We debated on charging and have implemented some other "policies" in our office regarding phone calls that we're going to try before we implement charges. This is what we're planning on charging: 99371 (Phone call, level 1) $25.00 (See CPT description) 99372 (Phone call, level 2) $50.00 Forms Fee $3.00 (we charge this currently) for any camp, sports, daycare or other forms that are not brought to the appointment with them. $25.00 per medical record (we currently charge this) to patient $45.00 per medical record to "other agencies" $15.00 prescription refill because it was lost or medicine was lost $14.00 per call for After Hours calls (this is what we're charged by our nurse triage service, we anticipate charging $15.00 per call) - ----- Original Message ----- From: "Karen Cookson" <> To: <> Sent: Wednesday, August 04, 2004 1:48 PM Subject: Charging for Telephone Calls > Hi, > I am interested to know if any other practices are charging for phone calls > made to patients after office hours? If so, can I ask what you are charging? > Do any insurance plans currently cover these charges? Thanks for the info. > Karen > group. > > ------------------------------ Date: Wed, 4 Aug 2004 15:16:39 EDT From: Subject: Re: BCBS not paying for ADHD In a message dated 8/4/04 11:41:02, writes: << I'm wondering if there would be any usefulness in trying to get ADHD reclassified as a Nervous condition rather than a Mental Health issue in the next revision of the ICD codes. I've heard there's a ICD-10 due soon.>> I think the dichotomy between mental/emotional diseases and physical diseases is totally false. However, the insurance companies know that they have a good thing going. Dan Nussbaum ------------------------------ Date: Wed, 4 Aug 2004 14:03:38 -0700 From: Subject: Re: BCBS not paying for ADHD So true. The head IS connected to the body. Also, not everything that looks like ADHD is ADHD. Other medical conditions have to be ruled out. Vicki > > I think the dichotomy between mental/emotional diseases and physical > diseases is totally false. However, the insurance companies know > that they have a good thing going. > > Dan Nussbaum > ------------------------------ Date: Wed, 4 Aug 2004 16:20:16 -0700 (PDT) From: kohlrussk <> Subject: Insurers and selective imm. coverage While we are on the insurance coverage issue...how about the insurer we just came across that does not include Prevnar in their immunization benefit for employees because it is not required for school and they ONLY cover those that are required? Or, how about the insurer that we cannot yet seem to convince that Hemophilus Influenza B shot is NOT a flu shot (causing us to repeatedly submit claims)? I sense that we will soon be reporting them to the insurance commissioner as we did another company who was telling us they only reimbursed for separate Hep. and separate HIB. and that we should bill the combination this way. We wrote the commissioner and reported them. After notification from the insurance commissioner (who "instructed" them to change their system within 30 days or else...) they did! One office CAN make a difference on a large scale:) Karen Kohlruss RN BSN Holland Pediatrics ------------------------------ Date: Wed, 4 Aug 2004 22:15:21 -0400 From: Harry Gewanter <> Subject: Re: BCBS not paying for ADHD We are paid for the E&M charges in Virginia for all those codes as long as we don't use the mental health codes. These are legitimate diagnostic codes and their usage is not based upon one's specialty. Harry Gewanter, MD Richmond, VA ------------------------------ Date: Sun, 08 Aug 2004 21:15:55 -0700 From: Michael Sachs <> Subject: L.A. Times Editorial - "Safer Vaccines for Children" http://www.latimes.com/news/printedition/opinion/la-ed-vaccine7aug07,1,19043 52.story EDITORIAL Safer Vaccines for Children August 7, 2004 Newborns with parents who conscientiously follow their doctors' advice become virtual pincushions. Babies get pricked and jabbed with needles nearly two dozen times in the first 18 months of life to protect them against once-devastating diseases like measles, tetanus and hepatitis. Added to the list is a new recommendation for toddlers and pregnant women: flu shots. But few parents are likely to be aware that along with the flu vaccine, their kids might be getting injected with potentially dangerous amounts of mercury. Drug makers have long added mercury-laced thimerosal to some vaccines to prevent bacterial growth. Mercury can cause neurological damage and learning problems, and many scientists worry about growing environmental exposures to it. There is a sharp and unresolved scientific debate over whether thimerosal in vaccines has contributed to a steep rise in reported autism cases. Thimerosal is often added when vaccines are packaged in multi-dose containers because repeatedly piercing the vial's rubber stopper with a needle can introduce bacteria. Until five years ago, kids getting a full range of injections were often exposed to mercury levels well above Environmental Protection Agency guidelines. But beginning in 1999, after requests from federal health officials and the Academy of Pediatrics, pharmaceutical manufacturers voluntarily switched to single-dose vials, which have only trace amounts of thimerosal, for most children's vaccines. The problem arises again because of flu shots. The only maker of influenza vaccine for toddlers, Adventis Pasteur Inc., already markets its product in both single-dose, thimerosal-free vials as well as multi-dose packages that contain the preservative. Assemblywoman Fran Pavley (D-Agoura Hills) has responded with a bill that would ban more than trace amounts of thimerosal in vaccines for children younger than 3 and pregnant women. Adventis opposes the bill, hinting that it might lead to vaccine shortages. To address this concern, Pavley amended her bill to allow thimerosal-containing vaccines to be used in the event of a public health emergency. Iowa has passed a ban on thimerosal, and similar measures are pending in other states and Congress. AB 2943 passed the Assembly in May and could come before the full Senate by mid-August. Common sense and prudence argue for its passage. If you want other stories on this topic, search the Archives at latimes.com/archives. Copyright 2004 Los Angeles Times ------------------------------ End of PedTalk Digest V1 #1037 ****************************** To unsubscribe: mail "" with with "unsubscribe"