We are out of network. We get our authorizations through Magellan but claims are processed by Blue Shield. When I check eligibility and benefits, it always says there’s a $ 2000/day max for inpatient substance abuse. But when I bill Rev Code 1002 with H0018, the allowed amount is $ 481 and they typically cover at 50% for out of network. Where does that $ 2000/day max come from if the allowed amount is going to be $ 481??. Isn’t it an all inclusive code, excluding maybe MD visits, but that wouldn’t come close to $ 2000. We get twice, three times their allowed amount with other carriers. Am I missing something? The owner is no longer wanting to take Blue Shield because he is so unhappy with the reimbursements. I am urgently trying to figure out a way to increase out reimbursement, without pushing the envelope, obviously.

Cross Posted because I am DESPERATE!!!!