BILLING TO SAG

By Leigh Perry

Blue Cross and Blue Shield of California no longer handles the claims for The Screen Actors Guild. These claims are now handled directly through SAG. The problem with SAG is that they do not feel that it is medically necessary, in most circumstances, for an anesthesiologist to provide the anesthesia for patients receiving EGD's and colonoscopies in the office. If you are an anesthesiologist that provides for this service and your location has patients that belong to SAG, it is very important to get a letter of medical necessity from the GI so that you can forward it with your bill to SAG. The letter must state the reasons why your services were required. Such situations as extreme anxiety, severe rectal bleeding, banding and removal of hemorrhoids, dementia or life threatening physical conditions could be reasons for medical necessity.

Even with this letter of medical necessity, there is no guarantee SAG will pay but it does give you a better chance. Of course, all of this depends on the relationship you have with the GI's office. If it is a congenial one, you can be more hopeful of getting a proper letter of medical necessity. If you do not have a good relationship then, quite frankly, good luck! You can try to argue necessity on your own with SAG, but they may not accept it. Even if you solicit the aid of the patient, it is rare that SAG will find in your favor. According to them, their medical review board had decided that there is no need for an anesthesiologist to give the sedation and even if you argue that you are providing Monitored Anesthesia Care, they will reply that this is also something that the does not require an anesthesiologist.

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