When a longtime patient visited Dr. William Sawyer’s office after recovering from covid, the conversation quickly turned from the coronavirus to anxiety and ADHD.
Sawyer — who has run a family medicine practice in the Cincinnati area for more than three decades — said he spent 30 minutes asking questions about the patient’s exercise and sleep habits, counseling him on breathing exercises, and writing a prescription for attention-deficit/hyperactivity disorder medication.
At the end of the visit, Sawyer submitted a claim to the patient’s insurance using one code for obesity, one for rosacea — a common skin condition — one for anxiety, and one for ADHD.
Several weeks later, the insurer sent him a letter saying it wouldn’t pay for the visit. “The services billed are for the treatment of a behavioral health condition,” the letter said, and under the patient’s health plan, those benefits are covered by a separate company. Sawyer would have to submit the claim to it.
But Sawyer was not in that company’s network. So even though he was in-network for the patient’s physical care, the claim for the recent visit wouldn’t be fully covered, Sawyer said. And it would get passed on to the patient.