Any insurance problems with DO's?

[Nanook]

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I read on another post somewhere that DO's in some specialties (such as surgery) can have problems with insurance companies refusing payment because they are not certified by (some acronym here--ABSM? ABSE?--I think basically b/c they are not an MD).

Anyhow, there is a Canadian doctor in my home town that is having problems with insurance simply b/c he is Canadian! I know that companies can be pretty flaky sometimes about this.

If anyone has knowledge of this, please post.

 

[DocGibby]

I'm just gonna throw this one out there with a disclaimer. I heard this from someone else. If it is incorrect please correct me, as I would like to know for sure.

I was told that most if not all insurance companies will not cover OMT. Other then that I've never heard of any DO specific denials by insurance companies. Both the DOs and the MDs that I've spoken to, however, equally complain that they have to fight with certain insurance companies and medicaid/medicare on a continual basis for payment.

 

[DO Boy]

I've heard what you've heard too docgibby. If anyone knows more info about this, please post.

 

[aefdompa]

I work for a major HMO in NYC and we do not reimburse for OMT. However, we do not distinguish between DO/MD's. They receive the same reimbursment.

 

[Nanook]

I guess more the problem that I was reading about was with DO's who had done a DO residency in a specialty like general surg or such (as opposed to an MD/ACGME residency), and were not certified by some organization. Thus, some insurance companies were refusing payment.

Anyone know of a DO who did a DO residency (ie, AOA) in a surgical specialty and is working somewhere other than an osteopathic hospital?

(I would like to qualify the above statements with the observation that this was all hearsay, so don't get too worked up about it).

 

[ewagner]

Regarding OMT and billing,

In Rehab Medicine (PT, OT, DO, MD, And some DC) most procedures regarding mobilizations, PROM and/or AAROM are billed as such (therapeutic ex, ROM ex, neuromuscular re-education etc.) but have certain guidelines under each code. Some state a certain amount of time must be spent, other state that it may be specifically used to alter mearsureable increases in ROM or are used to increase balance, timing, and or functional patterns for ADL's etc.
There are of course codes for billing of massage and manual techniques...but simply do not reimburse as well.
There are also codes for ADVANCED ROM ex...ones that the clinician must be present for at all times and require specific skill etc.

Now, osteopathic physicians have worked long and hard to have billing categories specifically for them under the heading of "Osteopathic Manipulative Therapy". These billing codes are more specific for area than they are technique, therefore are harder to quantify when insurance companies find issues with length of treatment, outcome studies, etc. SOOOOOO, when the outcome studies favor particular billing codes over others, those billing codes are MORE likely to be reimbursed for a higher value for a longer period of time (LBP: Therapeutic ex may have 40 billable units allowable, 4 Ultrasound units, 4 massage units, 0 ice or heat units)

So, lacking goniometric measurement of joint movement or progress, or the lack of rigorous outcome studies have somewhat hurt reimbursement of OMT billing.
So, to bypass the issue, most practicioners decide to accept cash only. Creating a non-used billing code or a code used by only a small, small percentage of clinicians per DRG.

It is something found throughout rehab.

hope this helps.

 

[mj]

Ewag is exactly right. I worked for an HMO and what gets reimbursed and what doesn't happens as stated. Our HMO would not reimburse OMM either.

Yes MDs and DOs were treated the same for payment of other codes, but DOs did get tied up in credentialing way more than MDs. Much of that depends on how well educated the credentialing staff is.

mj

 

[DocGibby]

This is why I'm shying away from having my own private practice. This insurance billing nonsense will bury you in a mountain of paperwork, not to mention the toll on one's mental health. It's enough to drive you to the brink of insanity. NO THANKS!! I'll work for the hospital and let them deal with it.

 

[jmor702]

Hey DocGibby,

That's why many doctors in private practice hire a clerk who works primarily with insurance claims. They handle that aspect of the practice for the doctor.

Believe it or not, it's worth it.

 

[DocGibby]

Yeah, but why should "I" pay someone to handle that nonsense. If you ask me, the insurance company should provide a rep, at their own expense to deal with it. It's their red tape, not mine.