[Ohioaap-practicemanagers] PHQ-9 Question

[Price, Jonathan]

?Thanks everyone for raising this concern.

  Since the 2017 version of Bright Futures started calling for depression screening (screening being the use of a validated tool) at every annual well visit starting at age 12, insurance plans that have to comply with the Affordable Care Act (which is most of them, except when an insurance provider is hired by a small employer to be simply an administrator of a self-insured plan) have to cover them.

   What's better than expected is coverage by Medical Mutual, since a lot of their business is administering benefits for exempt small employers.

   On the other hand, the big plans should largely be covering these and covering them as services not bundled into your well care charges.

  I'll take these results to AAP's PPAC which meets in Chicago tomorrow and Saturday. The Private Payer Advocacy Committee has one dedicated member to communicate for each large national insurer.

      Thanks again,

       Jon Price, MD FAAP

       Co-chair Ohio Pediatric Council

       Member, AAP Committee on Child Health Finance

________________________________
From: Ohioaap-practicemanagers <ohioaap-practicemanagers-bounces at lists.deltaforce.net> on behalf of michele.dritz via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
Sent: Wednesday, April 18, 2018 7:28 PM
To: Beth Barker; ohioaap-practicemanagers at lists.deltaforce.net
Subject: Re: [Ohioaap-practicemanagers] PHQ-9 Question

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We've also incorporate this screening into our regular practice for all adolescent visits (well visit and non-well visits).  Per our billing specialist, most of the insurers are reimbursing for it, though some of the insurers push the responsibility onto the family (at which time we then remove it).

Michele Dritz



-------- Original message --------
From: Michael Chamberlin via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net>
Date: 4/18/18 3:52 PM (GMT-05:00)
To: Beth Barker <BBarker at ohioaap.org>, ohioaap-practicemanagers at lists.deltaforce.net
Subject: Re: [Ohioaap-practicemanagers] PHQ-9 Question

Here is our experience (from my billing people) with the PHQ-9.  We have been using it as a screening tool at well child visits for age 11 years and up:

Humana - currently denies & tells us to adjust off
UHC - pays approx. $X and tells us to adjust off the rest
Anthem - pays 85% of the time (approx. $X) and sends to patient responsibility 15% of the time
Aetna - pays 95% of the time and sends to patient responsibility 5% of the time
Cigna - pays, 0 goes to patient
Med Mut - pays
Caresource - pays

Mike

--
Michael Chamberlin, M.D., FAAP
Pediatric Assoc. of Mt Carmel
4371 Ferguson Dr
Cincinnati, OH  45230
513-752-3650
513-752-3387 (fax)


On Wed, Apr 18, 2018 at 1:03 PM, Beth Barker via Ohioaap-practicemanagers <ohioaap-practicemanagers at lists.deltaforce.net<mailto:ohioaap-practicemanagers at lists.deltaforce.net>> wrote:
Hello! Please see this question from a practice in Westlake Ohio:

Can you tell me if insurance companies cover the PHQ-9 depression screening?  Also, do you know if there is problems with certain companies.  Thank you.
Couple months ago we started using the PHQ-9 but not billing for it.   We would like to start charging for the screening but wanted to know if any issues with insurance companies.

Could anyone help with this please??

Thank you,


Beth Barker BSN, RN
Director of Immunization Programs
Ohio Chapter,
American Academy of Pediatrics
Phone: 614-846-6258
Fax: 614-846-4025
Address: 94-A Northwoods Blvd. | Columbus, OH 43235
Website: OhioAAP.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ohioaap.org_&d=DwMGaQ&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=anTctJhkpqxmDnVS8isg6A3DFpkdXkHUmhm1G4xLxDjLJXy4c4XsjwCZ6bfhjUOI&m=X5ndryqCreWI5fEzyonZvjyLVEozpwNd92A88Co-g70&s=huyixxTKdHsKpuuW5ZWuWnhHunGJMgfBsMjkBZtjC7E&e=>


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