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Help me understand CPT

21 Posts
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CedarTide
(@cedartide)
Trusted Member
Joined: 5 years ago
Posts: 25
Topic starter   [#16018]

Insurance question, and the plan document contradicts what the counter told me.

Function beats pain scores in these conversations. “I cannot sit for twenty minutes” lands.

A clinician note carries more weight in the record than a patient request, so ask them to write it.

Ask for the refusal to be noted in the record. It changes the next conversation more than any argument.

Happy to be told the process is simpler than I think.



   
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birch313
(@birch313)
Active Member
Joined: 2 years ago
Posts: 6
 

Function over score.



   
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peak9304
(@peak9304)
Active Member
Joined: 5 years ago
Posts: 6
 

Half of what people describe as tolerance is a change in the underlying condition, and the two need different answers.



   
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rainatlas
(@rainatlas)
Active Member
Joined: 2 years ago
Posts: 6
 

You are not imagining it and you are not being difficult. Document it and take the document in.



   
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Carter
(@carter)
Famed Member
Joined: 2 years ago
Posts: 3036
 

Function over score. How long have you been on an appeal?



   
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oakbrace89
(@oakbrace89)
Active Member
Joined: 1 year ago
Posts: 7
 

Function over score. Not on an appeal but the pattern is familiar.



   
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vellumgrid
(@vellumgrid)
Active Member
Joined: 5 years ago
Posts: 11
 

Function over score.



   
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valethorn19
(@valethorn19)
Active Member
Joined: 5 years ago
Posts: 9
 

Interdose restlessness is distinct from the original symptom and worth naming separately. Two years in on an appeal and it lines up.



   
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meadow_fox
(@meadow_fox)
Active Member
Joined: 3 years ago
Posts: 11
 

Access to mugs should be on the clinical questionnaire.



   
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birchgrove46
(@birchgrove46)
New Member
Joined: 2 years ago
Posts: 4
 

Reference ranges differ between labs, so comparing two reports is close to meaningless. Tolerance was my main issue with an appeal too.



   
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tidebrace80
(@tidebrace80)
Active Member
Joined: 2 years ago
Posts: 7
 

Following this because I am in the same place and have no idea what to ask at the appointment.



   
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atlaslum23
(@atlaslum23)
Active Member
Joined: 8 months ago
Posts: 6
 

Ask for the longer appointment slot. Ten minutes is not enough for a complex history and pretending otherwise wastes both your time. Not on an appeal but the pattern is familiar.



   
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nimbus1488
(@nimbus1488)
Active Member
Joined: 3 years ago
Posts: 5
 

Changing prescriber does not reset anything, and people discover that the hard way.



   
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flintjig63
(@flintjig63)
Active Member
Joined: 3 years ago
Posts: 5
 

Is it normal to feel worse before better? Nobody told me that.



   
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isle2232
(@isle2232)
New Member
Joined: 2 years ago
Posts: 4
 

Ten percent cuts, of the current dose not the original. That is the arithmetic that keeps it survivable.



   
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