Actually Ron, you can't be a preferred provider under BC/BS of FL. They do pay for rehabilitative OT for 25 visits a year or something like that. They actually will pay, you just have to fight them tooth and nail for it. If I would have stayed in private practice, I would have fought this more. Some of my clients families (children) have fought BC/BS successfully for some OT benefits for their childrne. I would also complain about the Medicare representative because, obiviously, she has no idea what she is talking about. You can get your own Medicare number as an OT and bill separately.
Elizabeth H. Thiers, OTR/L FECTS [EMAIL PROTECTED] -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ron Carson Sent: Monday, February 02, 2004 10:00 AM To: [EMAIL PROTECTED] Subject: [OTnow] Lack of Parity As an OT in private-practice, I come across interesting situations involving insurance. Most situations, are less than encouraging and today is no exception. First, I learned that an OT Evaluation is not billable under my provider type at an Assisted Living Facility. However, a PT evaluation is billable under my provider type. In trying to understand the reasoning behind this disparity, I was told by a Medicare Representative that OT is viewed as a type or subset of PT. She then went on to tell me that as fare as medicare was concerned, that I could bill for a PT evaluation whenever I do an evaluation at an assisted living facility. Secondly, Blue Cross/Blue Shield of Florida does not contract with OT. Between OT, PT and SLP, they only contract with PT. What this means is that as an OT, I can not be a participating provider with BCBS. I can be a non-participating provider but this has reduced benefits for the client. BCBS says that most (all) OT referrals are made by PT's working at facilities. Whenever,a PT sees a client who they think needs OT they then make a referral to OT. The facility then pays the OT, either as an employee or a sub-contractor. A friend of mine told me that they would never be an OT because we are treated as 'second class citizens'. It's times like this I tend to agree. Ron _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
