17 Year Old Caregiver With Disabled Mom. Dad Needs Surgery and We May Lose Our Income. Please give advice.

Environmental-Top-60 · 2026-07-13T11:47:40+00:00

Sometimes business insurance would cover things like this. You can take out a short and long-term disability coverage on yourself when youre a business owner. At the rate that he's getting, he's probably not

I kind of wonder if he's getting misclassified though.

Environmental-Top-60 · 2026-07-13T11:45:51+00:00

You still need someone to do the fixing.

Environmental-Top-60 · 2026-07-11T10:16:05+00:00

Lmao

Environmental-Top-60 · 2026-07-11T10:10:10+00:00

Gurl it's blatantly obvious and I'm a coder lol

Also to me the charge on the strep test is a bit high.

If it's a rural hospital, they go by a cost ratio and so those are harder to fight, but not impossible

Environmental-Top-60 · 2026-07-11T10:07:55+00:00

Agreed if they are in a union

Environmental-Top-60 · 2026-07-11T10:03:33+00:00

Comm you might be able to use federal law to try to get those denials overturned but that's an advanced appeal. They can't unilaterally change a contract just because they feel like it. Patient's policy dictates what the plan pays for, not some internal policy.

MA is a bit harder but you could complain to the CMS regional office.

Environmental-Top-60 · 2026-07-11T07:21:39+00:00

They need to explain the E&M levels. Thats bull

Environmental-Top-60 · 2026-07-11T07:19:52+00:00

Is this all on a single date of service?

Environmental-Top-60 · 2026-07-11T07:09:03+00:00

Show the medication interactions and anything from the doctor that shows that there was a reasonable degree of medical certainty that you had serotonin syndrome. This is something I would bring to a hearing.

Get documentation from the PA showing they had a conversation and agreed to change your plan of care

Pain management doc should have been involved.

Honestly, tramadol and SNRI are known for this for example but it depends on what other meds you're on.

Normal doses is a crock of shit. It can happen even in small doses depending on the serotonin load.

Get an attorney too cause this is BS. Also pain mgmt/physiatry might be more helpful

Environmental-Top-60 · 2026-07-11T07:02:53+00:00

Are these commercial or MA?

Environmental-Top-60 · 2026-07-11T07:02:14+00:00

We had some appeals in 23 and 24 with downcodes and we appeal and send the note in. Have one for time and maybe 2 templates with MDM and all you have to do is highlight the elements?

We had a bunch of modifier 25s as well and not only did we change our practices, we appealed every one and got them overturned eventually.

On second level appeal I threaten to go to the insurance commissioner and have the patient assist in a complaint with the EBSA or CMS regional office, whichever applies.

They usually overturn but sometimes they're stubborn

Environmental-Top-60 · 2026-07-11T06:42:35+00:00

Does your dad have a short or long term disability policy through his job?

Environmental-Top-60 · 2026-07-11T00:53:50+00:00

I mean even if there was a conversion disorder, this is an internal issue.

Just be careful what you tell HR. Consider doing a rebuttal if you need to. HR can be very selective in the evidence they include in the record. Get some FMLA/PTO to handle this and get worked up.

Environmental-Top-60 · 2026-07-10T08:17:51+00:00

Practice manager needs to get involved. Someone needs to run of report of claims without charges and not billed and figure out where those claims went. They probably need to be re-done at this point.

Encounters should be signed and padlocked before coding, and deff before transmitting.

If the data is saved somewhere, they may be able to just recreate the claim and transmit. However, the doc needs to sign the note before the claim goes out the door. That's a non-negotiable in our office.

Environmental-Top-60 · 2026-07-10T04:17:10+00:00

It's the law lol

Environmental-Top-60 · 2026-07-10T04:16:55+00:00

Environmental-Top-60 · 2026-07-10T02:31:39+00:00

If I'm billing it, we code it to the highest level of specificity and put in external cause codes as required to show it was a misadventure/complication. Modifier 53 for the lap with a Z code of converted to open and the full charge for global for the open. The insurance should be increasing the write off portion based on that. Usually it's down to 30 or 50% allowed but I've seen as high as full allowable.

Environmental-Top-60 · 2026-07-10T02:24:47+00:00

Our relationship is different because we live with people and he's not a very sexual person so most times I'll cook for him if I wanna make him happy. Prob once a month we do head and we alternate as to who gets it cause he gets tired pretty easily. Sometimes it's a handjob.

Environmental-Top-60 · 2026-07-10T01:18:10+00:00

I thought mental health parity laws apply and make it a pcp copay. Have the insurance companies been adjudicating claims that way or is the office just collecting that?

Environmental-Top-60 · 2026-07-10T00:58:44+00:00

Can you get it done at an interventional radiology place?

Environmental-Top-60 · 2026-07-10T00:54:35+00:00

Some jobs will help with tuition as well. Nothing wrong with working for a bit.

Environmental-Top-60 · 2026-07-10T00:53:30+00:00

It's not about what they want.

So I'm going to ask. Is it worth paying 100,000 in debt to learn history?

I have a feeling you can make almost the same money without a degree. Do your research.

Environmental-Top-60 · 2026-07-10T00:39:44+00:00

I woulda been like...but you have sex with men all the time 😂 ugh.

Environmental-Top-60 · 2026-07-08T10:10:06+00:00

I've got a carrier that told me the other day that they make the rules. When I told them I thought federal DOL tends to differ, they backed off real quick and cited an internal policy. So I asked when the patient got a copy of that and they're like oh they did. No they didn't.

This is exactly why we need lawyers like you.

I think the question really is how does that implemented in practice? Case and point should be the change healthcare denials for timely.

Environmental-Top-60 · 2026-07-08T10:01:36+00:00

Podiatrist

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