The Healthcare Field

I work at a medical office. It is a small office, so as the doctor's assistant I do everything - assisting in surgeries, sterilizing instruments, working with insurance companies, setting up new patient charts, filing, etc etc etc. Basically, if it's not absolutely vital for the doctor to do it himself, I do it. Which is . . . a lot. In fact, I'm in the office more than the doctor is. But he did the 8 years of med school/intern/residency, so I'm not complaining.

What does suck though is when I do certain procedures on pts but don't get paid more for it. Legally everything has to be billed through the doctor. They treat me so well here though that it's hardly an issue.

Today's post is about the insurance side of things. I just spend an hour and a half compiling a packet to send to Medicare for a pt that we only saw once in December 2006. Medicare has denied the claim 5 or 6 times by now but here I am, dutifully trying everything I can possibly think of to get them to pay instead of billing the pt. (I think I've finally got it this time - I printed out pages from their website that describe what it takes for this certain code to be medically necessary. I highlighted all the criteria that we met and wrote a long letter describing each criteria in detail and showing how we've been saying this all along. There's no way they can deny this again with their own requirements slapped in their face! At least, I hope not.)

Patients don't see this side of things. They don't see the many hours I put in PER PATIENT anytime there's a problem with their insurance. These are hours I put in researching the specific code and company and their policies. Hours digging through CPT and ICD-9 books(coding books) to see if there's any other codes we could use instead that the insurance would cover. All the thousands upon thousands of dollars we've written off for pts that we feel have legitimate reasons for why they can't pay. Hours on the phone arguing with some rep in India that they're being stupid and this claim should be paid. Sidenote: I have nothing against India. Or any other countries, including the USA, who employ insurance claim reps. My anger is more when they're stupid and don't know what they're doing. I've talked to many foreign and domestic reps who were very helpful and knew exactly how to help me. In the end, sometimes there really is nothing I can do but bill the claim to the patient, like if their insurance policy doesn't cover such things, if they still have deductible to meet, etc. Every week when we do billing I end up with a stack about half an inch thick of claims that were denied for various reasons. If I had to guess I'd say maybe about 85% of those claims end up eventually being paid by insurance after many hours of work on my part, and about 15% are legitimately denied and are the patient's responsibility.

All I want to do is help people.

So it makes me frustrated when I have pts who get mad or don't understand why they should have to pay, or are mad that they're being billed for a date of service from 4 months ago. They don't realize I spent those 4 months battling the bill for them, or that it takes a MONTH on average for insurance companies to process claims and send them to us. What's most frustrating is when the claim denial reason was so simple that there is absolutely no way that the pt can deny they had an inkling. Such as, "we are not on your provider list." I mean, for the love, people! We do the best we can with this type of thing, but do you realize that there are hundreds of different types of insurance policies? And that, for instance, if you switch policies within the same insurance company we may no longer be covered? It is the patient's responsibility to know as much as they can before going to a doctor, including calling their insurance to make sure he's covered. Another line I "enjoy" is "I paid my copay, so why did you bill me this 10 bucks?" Okay, here's the secret: most insurance companies only pay 80% and you are responsible for the rest. Here's the sad part: it's not a secret! Insurance companies very blatantly explain this to their clients when you sign up. I've only seen maybe a couple insurance companies who pay 100%. The other secret is that WE don't determine the cost of medical services. We abide by whatever fee schedule YOUR insurance company has set. So don't get mad because you think something costs too much, because you'd be charged the same amount regardless of which doctor you go to. So people, please, take 10 minutes to do some simple homework before seeing the doctor. I don't appreciate being insulted or yelled at for your lack of brains.

Anyway, I realize this has transformed from a simple observation into more of a rant. I apologize for that, for anyone who may actually read this. But it's more for me - I try not to ever go on rants about this stuff when I'm talking to someone when I know they won't understand most of what I'm explaining, and also because I don't like to bother people, but it does feel good to finally get this off my chest.