Re: ?Insurances getting a clue finally

[Guest guest]

Insurance payments are not unlike a dangerous, addictive drug....Companies will keep increasing payments just enough to drag us along, but not change their general payment practices or their behavior in favor of our patients' care.

I was always excited about these sorts of letters, but then would discover a couple of months latter that they were back paying at the previous rate. After many agonizing hours on the phone and multiple emails asking why my payments were not correct, I would be right back to the same place-- not being paid for the work done.

" Tell us again, , how you really feel about insurance... "

Durango, CO

I was just about to get ready to drop Empire Blue Cross Blue Shield when today I get a letter in the mail that they are increasing their E and M rates by 60% !!!!!! I was getting so sick of seeing the adjustments larger than the payments for them. I have already stopped taking new patients with them a few months ago and was getting ready to make the plunge to drop them altogether. I guess I can hold off a little while longer! A lot of doctors in my area have dropped them so I guess they are listening. I think we need to do this more and things will change!

Margaret Coughlan

[Guest guest]

Like today, my biller tells me that insurance denied the E &

M code on a patient that came in with a Mallet finger and I applied a

splint. They paid for the splint application but said I wasn’t

entitled to an E & M on the same day.

Could you please explain how I was supposed to know she had a

Mallet finger and needed it splinted if I didn’t examine the finger

first? Is that maybe why orthopedists make patients come back the next

day for a cast?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of

Sent: Monday, August 04, 2008 6:55 PM

To:

Subject: Re: ?Insurances getting a clue finally

Insurance payments are not unlike a dangerous,

addictive drug....Companies will keep increasing payments just enough

to drag us along, but not change their general payment practices or their

behavior in favor of our patients' care.

I was always excited about these sorts of letters, but then

would discover a couple of months latter that they were back paying at the

previous rate. After many agonizing hours on the phone and

multiple emails asking why my payments were not correct, I would be right back

to the same place-- not being paid for the work done.

" Tell us again, , how you really feel about

insurance... "

Durango, CO

I was just about to get ready to drop Empire Blue

Cross Blue Shield when today I get a letter in the mail that they are

increasing their E and M rates by 60% !!!!!! I was getting so sick of seeing

the adjustments larger than the payments for them. I have already stopped

taking new patients with them a few months ago and was getting ready to make

the plunge to drop them altogether. I guess I can hold off a little while

longer! A lot of doctors in my area have dropped them so I guess they are

listening. I think we need to do this more and things will change!

Margaret Coughlan

[Guest guest]

On many things it is that you bill either the procedure or the office visit, but not both. Now the trick to do is to start knowing which ones pay more and submit the one that pays best. They got ya coming and going. That is why they have to go....

Re: [Practiceimprovemen t1] ?Insurances getting a clue finally

Insurance payments are not unlike a dangerous, addictive drug....Companies will keep increasing payments just enough to drag us along, but not change their general payment practices or their behavior in favor of our patients' care.

I was always excited about these sorts of letters, but then would discover a couple of months latter that they were back paying at the previous rate. After many agonizing hours on the phone and multiple emails asking why my payments were not correct, I would be right back to the same place-- not being paid for the work done.

"Tell us again, , how you really feel about insurance..."

Durango, CO

On Mon, Aug 4, 2008 at 1:39 PM, <drmargepol (DOT) net> wrote:

I was just about to get ready to drop Empire Blue Cross Blue Shield when today I get a letter in the mail that they are increasing their E and M rates by 60% !!!!!! I was getting so sick of seeing the adjustments larger than the payments for them. I have already stopped taking new patients with them a few months ago and was getting ready to make the plunge to drop them altogether. I guess I can hold off a little while longer! A lot of doctors in my area have dropped them so I guess they are listening. I think we need to do this more and things will change!Margaret Coughlan

[Guest guest]

You need to bill the fracture treatment code for the initial visit and not for

the splint, it is included. This is the global code that is for the entire

treatment of the fracture. Usually, about 300 adn includes the initial splint

application. You should not bill and E and M code. You can also bill for the

xray and the splint material. If you change the splint later, you can charge for

that and any repeat xrays.

________________________________

From: on behalf of Kathy Saradarian

Sent: Mon 8/4/2008 5:12 PM

To:

Subject: RE: ?Insurances getting a clue finally

Like today, my biller tells me that insurance denied the E & M code on a patient

that came in with a Mallet finger and I applied a splint. They paid for the

splint application but said I wasn't entitled to an E & M on the same day.

Could you please explain how I was supposed to know she had a Mallet finger and

needed it splinted if I didn't examine the finger first? Is that maybe why

orthopedists make patients come back the next day for a cast?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of

Sent: Monday, August 04, 2008 6:55 PM

To:

Subject: Re: ?Insurances getting a clue finally

Insurance payments are not unlike a dangerous, addictive drug....Companies will

keep increasing payments just enough to drag us along, but not change their

general payment practices or their behavior in favor of our patients' care.

I was always excited about these sorts of letters, but then would discover a

couple of months latter that they were back paying at the previous rate. After

many agonizing hours on the phone and multiple emails asking why my payments

were not correct, I would be right back to the same place-- not being paid for

the work done.

" Tell us again, , how you really feel about insurance... "

Durango, CO

On Mon, Aug 4, 2008 at 1:39 PM, >

wrote:

I was just about to get ready to drop Empire Blue Cross Blue Shield when today I

get a letter in the mail that they are increasing their E and M rates by 60%

!!!!!! I was getting so sick of seeing the adjustments larger than the payments

for them. I have already stopped taking new patients with them a few months ago

and was getting ready to make the plunge to drop them altogether. I guess I can

hold off a little while longer! A lot of doctors in my area have dropped them so

I guess they are listening. I think we need to do this more and things will

change!

Margaret Coughlan

[Guest guest]

I guess I used the wrong term but she had a partial tear of her extensor

digitorum longus. No x-ray, no fracture, just evaluation and splinting so I

can't go and back bill for fracture care, etc. I also don't have x-ray, not

that high tech. So your advice isn't appropriate to the situation.

And what if you don't do fracture care. What if someone comes into you with

an injury, you evaluate it, make a diagnosis, might have to stabilize before

you refer on? Do ERs not charge E & M codes and then for supplies, etc? I

am quite sure they do.

This is just another situation where the Insurance companies are robbing us

and instead of fighting we just try to find a different way to get paid. As

far as I am concerned that's like if you find out someone picked your pocket

and you say " oh well " and hit the ATM machine to withdraw more money.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

Re: ?Insurances getting a clue finally

Insurance payments are not unlike a dangerous, addictive drug....Companies

will keep increasing payments just enough to drag us along, but not change

their general payment practices or their behavior in favor of our patients'

care.

I was always excited about these sorts of letters, but then would discover a

couple of months latter that they were back paying at the previous rate.

After many agonizing hours on the phone and multiple emails asking why my

payments were not correct, I would be right back to the same place-- not

being paid for the work done.

" Tell us again, , how you really feel about insurance... "

Durango, CO

On Mon, Aug 4, 2008 at 1:39 PM, >

wrote:

I was just about to get ready to drop Empire Blue Cross Blue Shield when

today I get a letter in the mail that they are increasing their E and M

rates by 60% !!!!!! I was getting so sick of seeing the adjustments larger

than the payments for them. I have already stopped taking new patients with

them a few months ago and was getting ready to make the plunge to drop them

altogether. I guess I can hold off a little while longer! A lot of doctors

in my area have dropped them so I guess they are listening. I think we need

to do this more and things will change!

Margaret Coughlan

[Guest guest]

Perhaps you didn't include modifier 25. I would code that as a 26432( Closed treatment of distal extensor tendon,mallet finger) instead of an E & M code and still code splint application with a modifierLarry Lindeman MDLike today, my biller tells me that insurance denied the E & M code on a patient that came in with a Mallet finger and I applied a splint.  They paid for the splint application but said I wasn’t entitled to an E & M on the same day. Could you please explain how I was supposed to know she had a Mallet finger and needed it splinted if I didn’t examine the finger first?  Is that maybe why orthopedists make patients come back the next day for a cast?   Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing   From:  [mailto: ] On Behalf Of  Sent: Monday, August 04, 2008 6:55 PMTo:  Subject: Re: ?Insurances getting a clue finally Insurance payments are not unlike a dangerous, addictive drug....Companies will keep increasing payments just enough to drag us along, but not change their general payment practices or their behavior in favor of our patients' care. I was always excited about these sorts of letters, but then would discover a couple of months latter that they were back paying at the previous rate. After many agonizing hours on the phone and multiple emails asking why my payments were not correct, I would be right back to the same place-- not being paid for the work done. "Tell us again, , how you really feel about insurance..."  Durango, COOn Mon, Aug 4, 2008 at 1:39 PM, <drmargepol (DOT) net> wrote:I was just about to get ready to drop Empire Blue Cross Blue Shield when today I get a letter in the mail that they are increasing their E and M rates by 60% !!!!!! I was getting so sick of seeing the adjustments larger than the payments for them. I have already stopped taking new patients with them a few months ago and was getting ready to make the plunge to drop them altogether. I guess I can hold off a little while longer! A lot of doctors in my area have dropped them so I guess they are listening. I think we need to do this more and things will change!Margaret Coughlan