Insurance

 

Dr. Katta is a Medicare provider. 

For commercial insurance plans, she does not contract with any commercial insurance plans. Therefore, she is considered an "out-of-network provider". 

 

If you have a commercial PPO insurance plan, you may be able to receive partial reimbursement from your insurance plan when seeing out-of-network providers; some insurance plans offer this benefit and others do not. 

 

Can I get reimbursed for the patch testing procedure from my health insurance plan?

Many PPO insurance plans will reimburse you for a portion of the amount paid by you for the procedure, depending on your insurance plan and whether or not you have met your deductible. 

How can I find out how much I will be reimbursed from my insurance plan? 

1. Call your insurance company.  Ask if your coverage provides any benefits for out-of-network providers. 

2.  Ask what your coverage benefits are for out-of-network providers.  PPO plans provide less coverage for out-of-network providers as compared to providers that are in their preferred network.  

3.   Ask what the "allowable amount" [as set by your insurance plan] is for the following codes. These are the codes used during the patch testing procedure. Allowable amounts for each code are set by each insurance company separately, and in some cases may even be lower than those set by the government for Medicare.

All 3 of the following codes are used during the patch testing procedure:


99241: Initial Consultation
Either 99213 or 99214: Evaluation of test results and counseling
95044: Patch test units. This code requires a statement of the number of patches [units] placed. The number of units placed is always customized to each patient, but in general will range from 65 to 92 units.


4.  Ask your insurance plan what your deductible and out-of-pocket maximum is.   Many plans have a deductible, and the amount that you spend out-of-pocket for patch testing may be applied partially or in full towards this deductible. 

5. Ask your insurance plan how to request reimbursement. When you visit our office, you will be asked for payment at the time of testing. Following the testing, you will be given a statement to mail to your insurance carrier. This form will have the necessary visit and diagnosis codes that your insurance company will need to process your claim. If you qualify, your insurance company will then mail you a reimbursement check. Note that some insurance plans require you to complete a specific claim form.

6. Some patients have spoken with their insurance company about "network deficiencies". They have specifically asked their insurance company if there is any physician in the Houston area, who is in-network, who is able to perform customized patch testing for approximately 70-90 patches. If not, then some insurance companies may consider this a "network deficiency" and may choose to cover the testing and may then reimburse you at in-network rates. Every insurance company and every insurance plan is different, however. 


This procedure varies from company to company. Always contact your insurance company customer service center for a better understanding of your benefits and to get the most from your insurance policy.

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© 2019 by Rajani Katta MD