Doctors in the Poor House

by Insurance Guru

I was reading some letters to the Editor in a recent AARP magazine. Hey, it's my Dad's. Really! The letters were discussing "Disappearing Doctors" and laid the blame at the feet of Medicare reimbursement and byzantine insurance rules. Boy, that makes me cranky. Yes, I know about rising malpractice insurance, increased office costs, lower reimbursements, rules, regulations, paper work, etc, etc, etc...

What I don't understand is why these letter writers believe their profession should be immune to the life the rest of us are facing. I'm an average Jane out here in the world trying to get by. I face rising insurance rates, stagnant paychecks, increased costs, rules, regulations and paper work. I'm still trying to get it all together for the tax man.

Being in the Insurance Industry, I get daily e-mails telling me how to "Increase My Medical Office Accounts Receivables!" or "Avoid OIG Billing Audits!" or "Best Billing Practices for Diabetic Patients!". The subjects and e-mails are endless. There is an entire industry out there that is devoted to "show me the money" for physicians. Add to that the American Medical Association which has a yearly 18 million dollar budget to lobby Capitol Hill. That's just one group, there's another for Chiropractors, Hospitals and on and on.

I guess a lot of physicians aren't just like me. I drive a 2004 Ford, live in a small house, my kids go to public schools and we shop at Wal-mart and Target with coupons. In order to further economize, I got rid of the cable movie channels, magazine subscriptions and weekday newspaper. I take care of my own yard, house repairs and dog grooming. My 401K plan now literally means 401 dollars. I haven't checked yet, but I don't think there's a lobbyist out there on my behalf.

Physicians are highly trained and a valued part of our communities, but it can't be just about the cash and status. If it is, than maybe we are better off without the physicians that have chosen to leave. I want my doctor to want to help me and is willing to work as hard as the rest of us to pay the bills by doing the best we can with what we have.

Back From the Abyss

by Insurance Guru

Whew, what a grueling couple of months this has been. Deep in the Cube Farms on Insurance Island, we have been slaving away to get the 2009 Benefit Plans loaded, the 2009 Medicare rules, rates and insanities loaded, the 2009 contracts up and running and still hoping that claims don't blow up at the other end.

Insurance Cube Farmers rarely have a long Christmas or New Year's holiday. I myself worked straight through all the holidays and even through a couple of scheduled PTO days. It wasn't the best time to be told there are no raises this year and no assurances regarding future down-sizing.

However, a plane landed on the Hudson River and all survived, the Arizona Cardinals are going to the Super Bowl and a Black American is now the president of the United States. Has someone sent scarves and mittens to hell? This might just be my kind of year!

It's the Holidays which means... Open Enrollment

by Insurance Guru

Open enrollment, the bane of my December existence... While trying to budget for Christmas presents, cope with the extra workload at the office and praying I get to keep my job, I must sort through the various insurance plans being offered for the next year.

I use the term insurance with a bit of sarcasm here. You would think being employed by one of the nation's largest Insurance Companies, I would have the Cadillac Escalade of plans to pick from at a cost that would make mere mortals weep. NOT. The last 5 years have seen a steady decline in plan options and increase in cost for we cube farmers.

The plans offered to me are so hideous that I don't even use my employer's insurance. I've got the Guru's family enrolled on the Future Ex-husband's retiree plan. How absurd is that?

If I worked at Wal-Mart, I would get an employee discount, if I worked at a gym, I would get free membership, if I worked at AIG, I would get spa days. I guess I should just suck it up and count the twin blessings of employment and medical insurance.

During this joyous season of Open Enrollment, I encourage you to look at all the plan offerings and how each would cover you and your family in the year ahead. Consider if that dodgy knee or new baby is a concern. New glasses? Braces?

Most of all, if you are lucky enough to have an employer sponsored insurance plan, take advantage of it! A little insurance is better than none. Take a look at this little video that Dethmama dug up.

The Biller "Du Jour"

by Insurance Guru

Biller "du jour" -- I've been using this term for nearly 20 years to describe a phenomena that faces all claims examiners. You know how you ask for the "soup du jour"? Well, medical billers tend to stay just as long on the menu. They've got a tough job with low pay... so chances are that the biller you're dealing with is new on the job and under-trained. Since Insurance Companies and Providers interact in a kind of "delicate dance", a lightly trained rear behind the biller's desk could be courting catastrophe.

Here's an example: Biller Du Jour sends us a bill for an established patient visit for a yearly physical. Fine -- the diagnosis and office codes all check out, but then they tell us that these services happened at a surgery center. We have to deny that and send it back. A claim is a legal document -- we can't just have a chuckle and fix it. Well, we do chuckle.

The claim that still cracks me up is a physician inpatient visit. No problemo -- everything checks out except for the hemocult that was billed. Inpatient? Really, a hemocult is a card with some circles on it. You take it home and put some of your poo on the circles and mail it to the lab. My brain had a really good time trying to figure out what the doctor could possibly do in a hospital to get paid for that. (Insert Mission Impossible theme here) -- Dr. No stealthily visits patient X in the hospital, gloves up, checks for spies and quickly gets a poo sample. Dr. No slides the hemocult card out of his pocket, expertly applies poo to the circles, zips up the sample and it's back into his pocket and off he goes for a shaken, not stirred martini. Not. Gonna. Happen.

We all run into a Mr. or Ms. Du Jour -- probably on a daily basis ... The customer service rep on the phone, the "expert" computer person at Best Buy or the "top-notch" office staff at your PCP's office. Unfortunately ,in the insurance industry, it just creates denied claims and very unhappy patients. Your Insurance Company can't do anything about it short of telling the biller how to bill. Which is... Not. Gonna. Happen.

My apologies to past, current and future medical billers.... it's a tough way to earn a living.