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re: I hate our healthcare system and PAs/NPs
Posted on 8/11/17 at 10:47 pm to Spock's Eyebrow
Posted on 8/11/17 at 10:47 pm to Spock's Eyebrow
The minor aggravation of having to see/pay for an NP when expecting to see a physician is so far down the totem pole of fricked up things about the healthcare system. #1 for me are the able bodied/mind medicaid pts who pop up at the office for every minor ache and pain. It's like they don't realize that other people live with little aches and pains and prioritize their healthcare because they don't have money to throw out the window for a visit/tests because "sometimes I get this pain in my foot." We pay for that. That weighs much heavier on the scale of things thay are wrong with healthcare.
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Posted on 8/11/17 at 10:49 pm to SmackoverHawg
quote:
We hate being made out to be the assholes all the time.
It's a bad system for just about everyone except insurance company execs. On that I think we agree.
The problem is this. When a patient goes to his internist for his annual physical, which is nominally a "free" benefit he's paying $7,000 or more a year for, he might respond to the question, "Anything you want to talk about?" While he knows the internist isn't the specialist who could give a truly informed opinion, he says something anyway. The internist then assesses it for a minute or so, imparts no information that wasn't previously known, and maybe offers a referral. That turns the "free" annual physical into a $200 visit. Without the response, the insurance company may have paid the MD $120 for a 15 minute visit, which seems more than fair. With the response, the MD tacitly codes it differently, and the patient is on the hook for $200, with no credit for the "free" benefit. To get it fixed, the patient has to spend 30 minutes on the phone with the billing department. It's horseshite, pure and simple. If you don't want "to be made out to be an a-hole all the time," don't be one. That's pure and simple, too.
Posted on 8/11/17 at 10:53 pm to Spock's Eyebrow
You do understand that physicians have rules about how they have to bill, right? If they document (which they are also required to do) that they did xyz, then they have to bill for xyz. Otherwise it's fraud. They're not arbitrarily coding things to screw over pts.
Posted on 8/11/17 at 10:58 pm to drunkenpunkin
quote:
You do understand that physicians have rules about how they have to bill, right? If they document (which they are also required to do) that they did xyz, then they have to bill for xyz. Otherwise it's fraud. They're not arbitrarily coding things to screw over pts.
This. And I'll tell people, "this won't be covered under your wellness. If we address this today, you'll have to pay for this and the wellness will have to be done another day." If it's something minor or just answering questions, I just bill the wellness. But especially if tests, procedures or referrals are done, then it's not a wellness and would be fraud to bill it that way.
Posted on 8/11/17 at 10:58 pm to drunkenpunkin
They didn't "do" anything in my example. What you're saying is that every word, every finding is an opaque, billable event, even though it's addressed in the time allotted to the visit. What a patient-hostile system that is. While I hate wasting my time calling to get the coding reversed, I'll do it every time out of principle and because I'm paying over $7,000 a year for the privilege. "Anything you want to talk about" shouldn't be a trick question. Is that really such a foreign idea?
Posted on 8/11/17 at 11:02 pm to Spock's Eyebrow
quote:
"Anything you want to talk about" shouldn't be a trick question. Is that really such a foreign idea?
No, it shouldn't, and it should be part of a wellness. I agree with you. At least without more details I do. And there's a chance that your doctor doesn't even know these rules. We aren't ever taught them in training. We learn as we go and the rules changes every few months. And the rules are different from insurer to insurer. I've learned to try and bill things in a manner that benefits the pt as much as I can without being fraudulent and I try to inform the pt as best as I can when I think insurance won't cover something. However, that took years to learn the ins and outs and I still don't know them all.
ETA-and some doctors do try and screw the pt. Sad truth.
This post was edited on 8/11/17 at 11:03 pm
Posted on 8/11/17 at 11:04 pm to Spock's Eyebrow
I understand your frustration. What I'm saying is you're directing it at the wrong people. These are rules that providers live by. My doc is always trying to find a way to save pts a buck if he can. But, his handa are tied. He doesn't make the rules anymore than you do, and he hates them just as much. Probably more.
Posted on 8/11/17 at 11:13 pm to drunkenpunkin
Well, the guy I'm talking about once diagnosed essential hypertension during a "free" physical exam whose intent BCBS describes as finding conditions early that can be treated, and he coded it such that I was billed $300. He didn't chase zebras like a pheo or even schedule a follow-up visit. I was appalled. I called and got that knocked back to the standard wellness care visit. It's infuriating.
Posted on 8/11/17 at 11:18 pm to Spock's Eyebrow
That does suck. But he may not understand coding very well. And when you call and get things changed, odds are he had to talk with someone about his coding practices. He may just be a shitty person and not care about costs. But either way, the more times his charges are reversed, the more training he will receive. He'll capitulate eventually either because he finally gets it or because he's tired of dealing with it.
Posted on 8/11/17 at 11:26 pm to drunkenpunkin
Well, it's happened a couple of times in a row, and I don't think I can go back. When I find a new doc, I feel I should introduce myself by saying, "Hi, I have no major complaint, and I'm here for my free annual physical I pay over $7,000 a year for," and that really sucks. I don't want to have to say that. It's adversarial, which is the opposite of what we want.
Posted on 8/12/17 at 12:52 am to Itismemc
Ditto, a-hole
PA-C
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