I ran into this once with Blue Shield.  When I called, they said that
Alzheimer's
could be classed as "mental" depending...  They wouldn't tell me any more,
or
maybe the lower levels I talked to didn't know.

What had happened was that I scheduled a doctor's appointment for Mom
and she was due to have her blood pressure checked and lots of other
physical things.  However, I mistakenly said when I made the appointment
that it was for her to take the "mini-mental", because I had just heard
from Blue Cross/Shield that she needed to do so to get her Aricept
prescription authorized for another year.

That meant the visit went in with the first code for this "mini-mental"
exam, followed by the coding for hypertension and all the other
things.  The doctor's office re-submitted it with the physical codings
first, but the Blues weren't buying it.  I think I would have won on
an appeal, but I was tired, having spent 7 months dicking around
with an appeal on 2 ambulance rides (which I won).

I learned to say "blood pressure check" or "sore hand" or something
for every doctor's visit after that when I called to make the appointment
and things have gone smoothly.  That's the only time it happened and I
think it was because of the "mini-Mental" exam.  They paid for all
the MRIs and neurological tests as if it were organic, which it is.  She's
had several "mini-Mental" exams since then, along with her blood
pressure examinations.  The doctor gets paid for it, but the whole
visit does not go under "mental".

Right now I'm spending lots and lots of time dealing with medical
insurance.  I have learned a great lesson and I'm passing it on to
you.

Phone calls don't always work.  When there's a bill messup (about
every other week) I call and try to straighten it out.  If the
billing doesn't get straightened out and I get another erroneous
bill I don't call again.  I write up a letter saying I am disputing the
bill, address it to Legal/Complaint Department and send it
Registered mail with copies of every thing I can find, including
copies of my power-of-attorney.  This always gets a response,
even if I don't always get my way.  Certified mail would be
just as good, but Registered has a certain shock value.

Joan