Insurance Revolt

[Zenman1]

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Why have we not revolted against the insurance companies? I get so tired filling out forms when I know the med will be approved because I followed the rules and tried another med first. Why can't we bill the insurance companies for our admin time; guess that would make a good bill for our effective leaders to pass.

 

[deleted480308]

I was under the impression that (relative to other specialties) psych was already more likely to be cash based?

 

[Shikima]

You can bill insurance companies. A good way is also to provide a copy to the major news organizations when you do this as public shaming seems to work.

 

[F0nzie]

Will insurance even pay if you bill them for admin time? I do not accept insurance but I have a substantial amount of admin time just with prior auths and superbilling. I absorb those costs but I know plenty of other psychiatrists that bill the patient for that time.

Someone is going to pay for this and it's usually not the insurance company.

 

[Shikima]

Initially the insurance company will fight citing that you have no basis for your claim. However, it is reasonable to counter that said paperwork is not apart of 'normal' operating costs and time according to the contract. Further if you do not have a contract with the company, then billing the time for services provided is quite reasonable. Ask any lawyer, they do the same and they are more aggressive about it.

Just takes enough balls by enough people to stand up to the games and policies of 'deny all claims when they first appear'. There has a been a John Grisham book/movie about this.

But I'm not a lawyer and only am thinking with a relative amount of logic.

 

[Shikima]

I had been looking for this article and I feel it is related to the current issue at hand.

http://toprightnews.com/?p=7694

 

[Zenman1]

Wish I could find the letter, written by a lawyer, that a doctor would send to insurance companies that said something to the effect "I'm treating the patient in front of me while you're trying to do so from afar and within a license for this state." You get the gist.

 

[Shikima]

I had an attending send a letter to Express scripts after they denied stimulants for narcolepsy(?) and the Pt has been well established on it for years. He was on hold and billed them for the time on hold to solve this issue. Not sure if he ever received payment for his time on the phone.

 

[birchswing]

What I think is pretty bad is that some pharmaceutical companies are giving doctors crib notes on exactly what to ask their patients in order to get something approved. I am almost 100% positive my psychiatrist is getting a kickback from YouScript. She saw the rep right before she saw me. I came in and my psychiatrist's first question was if I had still been feeling "down." I asked her what she meant. And she said at my last appointment (3 months before), I said I was depressed. I clearly remember that I was anxious and not depressed. I've never been diagnosed with depression. She started talking about Deplin and how it can help me with mood issues. But instead of just prescribing it, she wanted me to do a genetic test called YouScript to see if I was metabolizing some B vitamin correctly to see if I needed Deplin. I told her that she had genetically tested me before (she had and then never even discussed the results). This genetic test was different, she said (she told me the last one was good for a lifetime). She asked me a series of questions that I am positive were to get insurance approval. She asked about meds I had taken in the past, if they hadn't worked for me, etc. Stuff you would ask on an initial consult, not after 3 years of regular med checks. She asked me about side effect reactions to meds I had taken 10 years ago. All the while she was scribbling things down. She presented me with a paper I had to sign saying I was financially responsible for the YouScript testing but she told me that she could 100% guarantee insurance would pay for it. All of this is so that she can tell if I should take Deplin, which after I got home I saw is for a disorder (depression) I have never ben diagnosed with.

I haven't seen her since the test, but YouScript sent me the results by mail and they look identical to the previous genetic test I had. On the back of the letter YouScript basically said they will go mafia style after my insurance company and not to worry about any bills I might receive. I've never seen anything like it before. I am almost positive that my psychiatrist was asking very specific questions that YouScript provided her with in order to make a case to my insurance company. To m it seems like fraud because I know I had a very similar test done before.

But I go along with it because I know who butters my bread. She's also a psychiatrist who charges for all the extras. She was a lawyer before becoming a psychiatrist so I think she has the billable hours mentality.

Anyhow, I'll be curious to see how she relates the YouScript to Deplin at our next appointment (assuming she remembers she ordered the test).

 

[Shikima]

I don't get crib notes. I wish I did. I just get lousy textbooks.

And I wish I got kickbacks, I wouldn't have to work as hard for earning a better wage.

 

[whopper]

A method I was considering doing, is if insurance denies paying for a patient's bill in the hospital, to give the patient the exact name of the doctor and that doctor's location that reviewed the case and decided to deny it.

In case you guys didn't know, some of these doctors that interview the inpatient the doctor to evaluate the appropriateness of the stay are intentionally rude and asinine. I had one guy, forgot his name, deny a patient, despite that the guy was still psychotic and violent and even attempted to punch me that very day of the denial. When I told this to the doctor, he told me, "well did he actually punch you?" I told him no because I ducked. "Then there's no violence."

While the patient cannot sue the doctor that denied coverage, it could lead to the patient possibly calling the news, or complaining to that doctor's state medical board and reporting the doctor.

I never pushed it to the level where was going to execute the idea. Most docs just get ticked off and let it ruin their week but that's it.

I was going to call the hospital's legal dept to see if there was anything wrong with it. If they didn't think so, I was then going to pitch the idea to the department to see their opinion.

What killed the idea is I left U. of Cincinnati, and at the new place where I work, I don't have to deal with insurance companies.

 

[jettavr6]

A method I was considering doing, is if insurance denies paying for a patient's bill in the hospital, to give the patient the exact name of the doctor and that doctor's location that reviewed the case and decided to deny it.

Good idea, but insurance companies are already adjusting their tactics here. The name of the game is political influence and insurance companies/hospitals have won this battle a long time ago. In California, there are now "anonymous" reviewers for medication decisions. When I called to complain, it was explained that "new legislation" enacted made this practice totally legit. It is sickening.

There is really no way to charge the insurance companies for the time that you spend filling out forms. The best way is to enact policies and collect the fees up front from patients. All of this sucks, but there isn't much else that can be done.

 

[TexasPhysician]

Have patients pay for completing PA's and forms. Patients revolting would be much more effective.

 

[Zenman1]

Have patients pay for completing PA's and forms. Patients revolting would be much more effective.

Hey Mod, could you move this thread where there is more traffic?

 

[TexasPhysician]

Hey Mod, could you move this thread where there is more traffic?

As the question does appear to be toward all physicians, I'll move it to practicing physicians to see if we can get broader responses from those with more experience.

 

[Winged Scapula]

As the question does appear to be toward all physicians, I'll move it to practicing physicians to see if we can get broader responses from those with more experience.

Probably not the best place to move it.

Practicing Physicians is a *closed* forum. That is, only members that I have personally vetted as possessing Attending physician status can respond to posts here. I suggest General Residency as having the most attending physicians at a time to foster open discussion, which would include residents, students and non-physicians.

I don't have much to add since, as a surgeon, I prescribe very little medication other than narcotics and antibiotics. However, we do bill the patient for completion of FMLA and other such forms and for treatment denied, I do provide the patient with the name of the insurance company physician who denied the care during the peer to peer, as well as document denial of treatment in their chart.

 

[ferning]

Good idea, but insurance companies are already adjusting their tactics here. The name of the game is political influence and insurance companies/hospitals have won this battle a long time ago. In California, there are now "anonymous" reviewers for medication decisions. When I called to complain, it was explained that "new legislation" enacted made this practice totally legit. It is sickening.

There is really no way to charge the insurance companies for the time that you spend filling out forms. The best way is to enact policies and collect the fees up front from patients. All of this sucks, but there isn't much else that can be done.

Thats how all US busiesses work, protectionist policies for the "free market" and government handouts in tax breaks

My goal is to run as slim an operation as possible and just collect specialist copays and provide generic nonnarcotic meds in office for the dispensing fee, as well as convenience. Maybe take one insurance if i can negotiate it to not require much more time than writing a check.

Plus take as much as humanly possible off the books or through bartering. Id rather live on the streets than pay student loans and huge taxes.

Documentation, progress notes, and coding are the distraction to keep you thinking. Leave as little time for free thought so you blindly carry out clinical medicine, a corrupted science, whos only real purpose is to feed the healthcare economy. Sure lets inject steroids for any old person with joint complaints. more syndromes that end up just reflecting physiologic reactions to invasive diagnostic and treatment procedures or drugs. And god only knows how many unnecessary surgeries. 30 years of formal education teaches you not to ask questions out of turn though and regurgitate in a disciplined manner

 

[Arcan57]

Thats how all US busiesses work, protectionist policies for the "free market" and government handouts in tax breaks

My goal is to run as slim an operation as possible and just collect specialist copays and provide generic nonnarcotic meds in office for the dispensing fee, as well as convenience. Maybe take one insurance if i can negotiate it to not require much more time than writing a check.

Plus take as much as humanly possible off the books or through bartering. Id rather live on the streets than pay student loans and huge taxes.

Documentation, progress notes, and coding are the distraction to keep you thinking. Leave as little time for free thought so you blindly carry out clinical medicine, a corrupted science, whos only real purpose is to feed the healthcare economy. Sure lets inject steroids for any old person with joint complaints. more syndromes that end up just reflecting physiologic reactions to invasive diagnostic and treatment procedures or drugs. And god only knows how many unnecessary surgeries. 30 years of formal education teaches you not to ask questions out of turn though and regurgitate in a disciplined manner

I like this post. What is lacks in coherence or logic is more than made up for in providing an insightful window into the poster's psyche. Bravo!