Arghhh! Healthcare costs, coding and insurance companies!

[Serial Mom]

I imagine many of you have gone thru similar situations but our healthcare system sucks!

I had a problem with a preventive physical exam that I had to have 3 special tests (2 were 'considered' surgical in office) and the clinic billed the insurance company for the surgical tray with sterile equipment separately in both cases. My insurance company said it was NOT COVERED! I asked them how can they apply the procedure to my deductible (of course I have to pay that), but not even cover the equipment - do they think the Dr. can do the procedure with his hands????? They blamed the clinic.

So I called the clinic as to how things are coded and how the insurance accepts this coding! Either the clinic will have to include the tray charge in the surgical cost or they will make me pay for it or write it off.

What I don't undersatnd is that if I pay for healthcare coverage that will cover the surgical instruments used, why is the coding an issue - if it is in my benefits package, they SHOULD PAY FOR IT! They are like dubya - it has to be their way or no way!

un - fucking - believable!

[phantom power]

1. Stories like this are why I laugh at the rubes who worry about "govt bureaucracy"

Yeah, because the bureaucracies of the private health care industry are soooooo efficient.
:eyes:

[Jackpine Radical]

2. Welcome to Wonderland.

The insurance companies just announced a new set of procedure codes in my area, with no clue as to what they would or wouldn't pay for, and what the relative reimbursement rates are. If I bill a given test as a neuropsychological test, will I be paid differently than if I bill it as a general psychological test? Probably. What will the difference amount to? Who knows?

[phantom power]

3. You know what's ironic...

Every time the health insurance companies make their bureaucracies more complicated, and more unaffordable, they reinforce the argument for nationalized health care. If they really want to undermine the national health care movement, they would take some steps to make themselves more affordable and easier to work with.

As it is, they are putting nails in their coffin.

[Lugnut]

6. The sooner the better with the nails.

When Republicks complain that a single payer universal health care system would take choices away from the insured I want to scream. That's precisely what the for-profit insurance companies do right now. What world are they living in because it's not mine? :mad:

[Serial Mom]

4. No wonder a high percent of doctors FAVOR universal healthcare!

I just wonder what repuke invented the business of CODING! After doing a little research, some of the companies that do coding for either clinics or hospitals were bought-out by... you guessed it, insurance companies!

[ellacott]

9. Coding is not a bad profession

The problems come when they are too close to insurance companies. I haven't heard of many coding companies that are being bought out by insurance companies but this is a bad thing. There are definately conflicting interests.

[Jackpine Radical]

15. The whole concept of a HMO is a conflict of interest.

You have the insurer & the provider both interestd in saving money at the expense of the patient. Docs get rewarded for holding down costs, etc.

[ellacott]

18. I hate HMO's

Many doctors don't like it either because they have to compromise on patient care.

[Serial Mom]

19. I never said coding was a bad profession

but it was only invented by the insurance companies. It may have created a lot of new companies and jobs, but that doesn't make it right.

It's drawbacks are making the coding business & insurance company more money by coding things in way too much detail. It makes it so complicated no clinic or hospital could possibly follow the coding rules of each insurance company!

I worked in a hospital 35 years ago and know how/when coding began! It was ONLY used by hospital to make sure that every pill, every speck of tape, every view of xray was charged at its full rate, no matter what the doctor ordered and was properly billed to insurance. THEN INSURANCE COMPANIES GOT INVOLVED and that is where the problems began.

[ellacott]

22. It wasn't invented by insurance companies

Coding also maintains important statistics. I'm not aware of these new companies. I have to do some research on this because that is a huge conflict of interest. Coders and insurance companies have been long time adversaries.

If you think coding has too much detail just wait until they start using ICD 10. They are already using it in Europe.

[ejpoeta]

21. well think about it.... instead of treating patients, they have to spend

a chunk of time just dealing with insurance. how much does that cost them, i wonder. it's ridiculous!!!

[fed_up_mother]

5. I had to get online and figure out the coding error myself

Seriously. :(

[jwirr]

7. Previews of coming attractions - Insurance based universal health

care.

[cabluedem]

13. Say it aint so! nt

[ellacott]

8. I do coding

Surgical trays & dressings are usually bundled into the procedure and very rarely paid...never paid by Medicare. They shouldn't make you pay for it because they should have been aware that this code is rarely reimbursed. Clinics usually get paid a higher rate of reimbursement for those surgical procedures. Medicare guidelines(which most insurers follow) state that the patients can not be billed for this.

You clinic should write that charge off. Hopefully they won't try to get you to pay it.

[Serial Mom]

12. It is all shenanigans...

If the clinic writes it off (which they said they may do when they get all the info from my insurance posted to my account, which hadn't happened yet), AND AS YOU SAY, they get paid a higher rate of reimbursament for those surgical procedures I PAY THAT HIGHER RATE then, because it goes toward my deductible first! It is DISHONEST to let a clinic WRITE IT OFF AS A LOSS, when the insurance should be paying it and and the dishonesty is not just because of the code!

I hope you see the point of many people like me paying more for the health insurance premiums and paying more of deductibles, and paying more for out of pocket expenses, and paying more for prescription costs when BOTH THE CLINIC and INSURANCE COMPANY KNOW HOW TO SKIRT THE SYSTEM IN THEIR FAVOR!

[ellacott]

17. Oh I know

I'm definately not being an apologist. I have health insurance also and have to pay deductibles and out of pocket expenses like everyone else. I've been in the field for over 30yrs. and have seen many things. I'm just explaining what is going on. When they write off a charge it's deleted from your account. Many institutions over use write offs and I agree that it shouldn't be done. By writing it off they are taking a loss but it still needs to be documented.

[Serial Mom]

20. They are taking an UNNECESSARY LOSS to offset

all the money they make to assure they remain "non-profit" in most cases.

It is ALL ABOUT GREED!

[ellacott]

23. Greed is definately a factor in healthcare

But the write-offs don't neccesarily offset any profits. They can make zillions of dollars and still remain "non-profit". They just have to reinvest those profits back into their instituion.

The problem with writing off so much is that they are also eliminating their paper trail and this has an impact on quality care.

[RobinA]

10. Insurance Companies

have something called "administrative cost savings." What this translates to is "claims we found a bush*t reason not to pay." This includes such things as: wrong codes, wrong dates, paperwork they claim they never got but which they earlier indicated they did get, "lost" paperwork, etc, and some other tricks I'm sure are in their little Handbook of How to Screw the Claimant that they keep under lock and key in their own little section of hell. They figure, rightly, that a certain number of these non-payments will not be pursued, hence, money saved for them. My policy is this: pursue insurance companies to the ends of the earth. Do everything they say, to the letter, to avoid giving them more reasons to throw barriers in your path. Appeal, appeal, appeal. Retain a dated copy of every single item that you send them, because losing things is one of their favorite ploys. Send certified whenever possible. Bare in mind that they are eventually lazy. You can grind them down much of the time, but you have to make it your mission. I rarely expend this much energy on other bureacratic mistakes, I just pay to get on with my life. But insurance companies....not one penny will I leave on the table when it comes to those thieves.

[Serial Mom]

14. Good for you

It is easier for some person on the other end of the line who just has a book in front of them to blame coding or coverage to not pay and hope you won't pursue it!

[cabluedem]

11. I simply will not pay for incompetance or a blatant ripoffs like this. Single Payer Now! nt

[notadmblnd]

16. Something happened in the last 15 years with health insurance billing

when my husbands cardiologist was in practice by himself, we never got a bill for an office visit it was all billed to the insurance and it was covered. When the cardiologist decided to get together with a bunch of associates and incorporate and implement their assembly line style of medicine, the bills from the physician started pouring in. It seemed that nothing was covered any longer.

It was like the billing people who had been on the job for years and knew the process were all let go and young kids right out of school we put in their places and they weren't properly trained.

Our insurance covers 100% of lab work, emergencies and hospitalizations. However, it does not cover office visits. My sons pediatrician still does business the old way though. If he is sick and I have to take him in for let's say an asthma attack, the Dr will bill it as an emergency and the visit will be covered. If I just take him in for a routine exam, I will be billed 60.00.

He now seems to have someone new in the office doing the billing because last time I took him in I received a bill for lab work. I called the lab and they told me that the Dr office had coded it wrong and needed to resubmit it. I called the Dr office and told them this and I assume it was taken care of because I haven't received another bill from the lab.

It is unfortunate, that we as consumers must know the process and procedures for billing as well as their paid professionals do if we are going to be able to advocate for ourself when we've been unfairly charged. But we do.