Changes in usual and customary
Over several years, I've spent a lot of time looking at EOBs and identifying errors in our claims. I've repeatedly found errors that resulted in reprocessing in our favor, so I feel that I have a better than average understanding of how our OOP insurance benefits work.
But this one has me puzzled, and I'm not sure what to do next.
My partner sees a therapist once a week. It's out of network. We submit the superbills to insurance every month ourselves. Each month, the provider, CPT, diagnosis, location, and the provider's charge for service are the same.
Why does the "allowed" amount change from month to month?
When I point this out to the claim supervisor who has worked with me through months of reprocessing, he says these claims are covered at the "usual and customary".
Is it usual for the UCR to cycle back and forth from month to month?
submitted by /u/TweezleSnoofThe2nd
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