LTCH and Bi-Polar Disorder or other mental/ behavioral disorders.

[Captain Bligh]

If he (or you, for that matter) are looking for insurance to cover the visits and or meds, almost all insurance plans require a diagnosis of a relevant condition (even if the diagnosis is simply general anxiety) prior to paying the claim. In fact, a diagnosis code is a mandatory field in most implementations of the 837P (the electronic format used by providers to submit claims for payment) and is a technical requirement of the new 5010 version that is being implemented by many providers this year, IIRC.

This is not as harsh as it may seem at first as the insurance companies have a responsibility to ensure they are not paying for unnecessary treatments and without at least some diagnosis, they would have to be far more intrusive in order to even attempt to review claims for medical necessity.

If you are paying out of pocket and not having claims filed with the insurance company, of course, this does not necessarily apply. (Note: paying a deductible or copayment means the insurance company must still receive and process the claim.)

FWIW, a General Practitioners are not the folks I would see for proper Med management. There is simply too many variables and cross-relationships for them to keep track of in the amount of time they have to research the various families of medication.

Very good advice here. I am a practitioner. Any billing going through an insurance company will have a diagnosis. The practitioner may or may not have told a person that a diagnosis has been made or what the diagnosis is. However, that does not mean that a diagnosis has not become part of the records.

As a practitioner, I am not required to submit reports to any governmental entity about who I have assessed or what their diagnosis may be.

In 28 years of clinical practice I have only been requested to submit mental health info related to guns once. It had to do with a client who had guns confiscated by LEOs. I was requested to attest to client as safe to self and others before his guns could be returned.

 

[wilianknow]

Get the help you need is the most important thing to do.