Insurance Companies Have No Accountability

[jmj11]

Everyday I see rejection letters for bills that we have submitted to insurance companies, and I have a damn good biller.  But the insurance companies have no accountability and are bullies to small, independent practices.

 

We have had bills rejected for a) using a PO Box, even though the insurance company only uses PO Boxes, b) spending too much time with a patient (a patient that has been to several major headache clinics, including Mayo Clinic and has had multiple procedures done, including a brain surgery, and is on about 12 daily meds) so they paid 0.  I had to spend almost two hours with this patient and didn't get a cent.

 

Well, the list could go on and on. But this example cracked me up.  We had a $500 bill rejected because we submitted it on a claim form that was written in red ink, just like they requested, but it wasn't the EXACT same color of red as they required. So they didn't pay one cent on a $500 bill.

 

 

http://www.pacificrimheadache.com/wp-content/uploads/Bill-Rejected-Due-to-Wrong-Ink.pdf

[GetMeOuttaThisMess]

On a personal note, I've had to contact an insurance carrier for a second time regarding a non-emergent ambulance transfer for a parent in which they covered the from facility to doctor's office but are requesting more information from the provider on the return trip.  Go figure....

[MedicinePower]

JMJ, are you able to resubmit and get reimbursed? Does the patient become financially liable if insurance absolutely refuses to pay? How much of the billing is doing electronically vs on paper?

[jmj11]

JMJ, are you able to resubmit and get reimbursed? Does the patient become financially liable if insurance absolutely refuses to pay? How much of the billing is doing electronically vs on paper?

This was probably resubmitted.  I don't know the final outcome on this particular case but this is just an example of the daily grind  Most of our are submitted electronically.  I don't know why this one was on paper.

[PA-Larb]

What a crock of BS

[ventana]

you experience with insurance companies is one of the biggest reasons why I developed a single-payer practice, geriatric healthcare   And I only accept Medicare.  It works.  One set of rules.

[jmj11]

Right now Medicare has not paid me a penny for over a month because their contractor audited our practice and saw that over the past three years I've had 30 new patients sent to my by my old neurology practice.  I saw then each as a new patient because they were new patients and I billed them as such.  This contractor determined that since a PA is an extension of the physician, and that a physician cannot refer a patient to himself and bill that patient as a new patient, they determined that my old Sp could not refer a patient to me (an extension of my old SP) and me bill that patient as a New Patient because because the patient had been seen previously by my old SP even though that physician is not presently my SP.  I'm in the middle of a big battle with them right now that can go on for months and in the meantime we see all medicare patients for free.  However, I agree that it would be easier to deal with one insane person than a whole room full of insane people.

[discogenic]

Are you still submitting bills to Medicare for those patients you are treating?  Hopefully you will only be treating them "temporarily free" instead of free once this gets straightened out.  But it will probably take forever to get straightened out and you don't want to go beyond the billing deadline.

[swooshie1]

I'd consider sending that example to the news media - IMO the average consumer / patient doesn't have any clue what providers have to deal with, as they complain about the expense of healthcare, and so on.

[jmj11]

This is constant, every day, and something new each time.  

[genuineonline]

Great information, thank you so much for sharing this with us.

[jmj11]

Having to deal directly with insurance company executives over the past three years, I'v come to realize that they are the most poorly educated in our society about what we do . . . maybe second only to legislators.  I got a letter yesterday that Atena has changed their contracts so that when a PA, NP or RN does a procedure, that the first procedure is paid at 85% of what they pay physicians (which isn't new as this is CMS position), but then they added that if the PA, NP or RN does a second procedure on the same day, on the same patient, they will pay them about 35% of what they would pay an MD doing the second procedure on the same patient and if they do a third procedure on the same patient, on the same day they will pay 21% of what they would pay a physician for doing a third procedure.

 

When I've argued with insurance companies they say, in a matter of fact way, that since PAs deliver far inferior care so they feel they can pay far less than they do for MD services.

[bradtPA]

It's really getting out of hand. I was told by our billing service yesterday that Medicare will no longer pay for HgA1Cs if I use 250.00 or 790.6 as a justification, it MUST be 250.02 (uncontrolled DM) or they will not pay. Not every diabetic is uncontrolled, and we have to run the darn test to take care of the patient properly; this is going to force me to use 250.02 irregardless just so I can continue to do my job.....