Insurance Rant #99887789999

I'd just like to preface this little rant with a disclaimer: I love most of my work at Hahn and Nelson Family Medicine. However, it seems to be the work of our insurers to suck every little piece of joy out of life that they can. Once in awhile, though, I'll talk to someone who seems to really care. That happened today, after almost an hour speaking to other not-so-caring sheeple.
So one of our patients was told that she had to pay an out-of-network deductible because Aetna told her that the physician she saw was not an Aetna participant. Well, we are, and have been since at least July 15. Of course, this is after months and months of filling out forms and sending in duplicates of duplicates of licenses, etc. for the 12 or so insurance companies we wanted to cover. Don't even get me started on the incredible inefficiencies of the credentialing process (like, why isn't there ONE form, ONE set of standards, to credential physicians?)
So I called Aetna this morning... first thing on my to do list.
8:30 Called Provider Services and made my way through the maze of what number to press, inserted my Tax ID, etc. etc. and got someone on the line who said they couldn't help me because my providers were not linked correctly. We are credentialed, yes, considered participating, yes, but we're not linked correctly to our "service area." What does that mean? My head is just starting to spin. The trip to insurance world has begun. OK, so what number do I call? Got it.
8:45 Called the number I was given, which turns out to be claims, typed in the correct numbers for our tax ID (is there any way to put that on speed dial?) and my patient's ID number, blah blah blah. Got "Jen" on the line who looked up the claim and said that the claim had been processed under an incorrect Tax ID. I replied that that's strange, because the correct tax ID is on my Explanation of Benefits that came back from the claim. She replied that it must be a problem with my biller (yeah, right, let's pass the buck! quickly!). I sighed (deeply) and agreed to call Office Ally to get them to check things out.
8:55 Called Office Ally. They are so  nice to work with... someone picked up the phone immediately -- I only had to press one number on my phone's keypad. Nobody even asked me for an ID number. The representative assured me that the claim contained the correct Tax ID. I asked him if there was anything else that might've caused this to happen, but he was mystified. But he did ask me to call back if there were any other issues. OK, I called them, now back to Aetna.
9:00 Called Aetna back. After having to type in the patient's ID, Date of Service, etc. again, I had to listen to the claim details before pressing "0" to get a representative. It's now 9:10 because I accidentally asked for a fax of the claim to be sent.... duh. But that kind of stuff happens when you're in the altered universe that is the Insurance phone call.
9:10 OK now I have a very competent person on the phone, Sonya. She has the claim information already that I've typed in, but asks a few identifying questions. She tells me that the Tax ID number is fine. It's ours and she doesn't know why both the patient and myself have been told that it was incorrect. But she also verifies that the patient was billed for an out-of-network provider when she shouldn't have been, and gives me a resubmittal tracking number. I'm still concerned about why both the patient and myself were told about the incorrect Tax ID number, and ask to speak to the representative that told me about it. She tries to get my friend Jen on the phone but she's busy. I leave Sonya with my phone number and email address because I'd really like to know why it is that Jen was seeing something completely different from Sonya. Sonya is now my new best friend. Sonya gets busy trying to investigate the mystery herself. She's very thorough, and finds the provider that Jen said the claim was mixed up with but cannot figure out why someone thought it was linked to this claim. Now it's 9:33 and I've been on the phone for an hour. I have a stack of payables and checks on my desk along with some other more fun projects...
9:42 So I called the patient to just kind of wrap things up. She had originally gotten an email about the claim so she's sending that to me. I don't want to become obsessed with this. Blogging about it really helps. Not only will it help me journal my way through this learning process, it also helps me blow off steam!

Update: Sonya called back to tell me that Jen was, for some inexplicable reason, looking at two claims from JUNE. JUNE. We weren't even open yet. Hmmmmm. Hey, I don't know want to hear anything from people who claim the *government* can't run healthcare when this kind of stuff is happening in the private healthcare industry where people are paying dearly for their coverage. Of course, let's see what happens next week when we start filing our Medicare claims! Stay tuned....

Walk Across Maryland is a Huge Success!

Thanks to all who came out to walk today. Leading up to the event, people frequently asked me "What is the walk for?" The answer was, YOU! The Walk Across Maryland is a way to make people aware that exercise is easy to access. Most people just have to walk out their door and there it is: a sidewalk. Others (like me) jump in their cars and drive a short distance. My favorite destination is Cacapon State Park. I go out there every couple of weeks and follow my favorite hiking trail. It's a bit wild, and the trail is far from perfectly flat, but it's a great workout. Part of the attraction is watching the environment change through the seasons. Some of us stop along the path and leave stacked stone sculptures. It's a jewel of a place.
Other days, it's just as easy to drive to the C&O Canal in Hancock. There, the trail is paved and flat. I can go a bit faster here and I don't have to be on the constant alert for branches, snakes, and bears. I love sneaking peeks of the river; sometimes I'm startled to hear one of the small airplanes that use the airstrip that runs alongside the railroad tracks on the West Virginia side of the river.
There are a couple of other walking alternatives here in Berkeley Springs: a cross country trail runs around the Intermediate and Middle Schools, and there is a new trail on the north end of town but I don't know a lot about that yet. I know there are still a lot of fans of the track, but this just isn't my thing. I suppose if I put on my iPod I could make it around a few times without falling asleep. But that's ok -- everyone needs to find their own thing and "just do it!"

Oxbow to the rescue

I was just eavesdropping on my husband's phone conversation with his Oxbow colleagues. They're deep in discussion about how to bring their Electronic Medical Record (EMR) software to market. He was reading them a Journal of the American Medical Association (JAMA) article
(sorry, unless you have a membership you'll just be able to see the extract here) about how the current EMRs on the market don't provide good querying capabilities since most of the record is in "free text" format. This gives OK information on an individual patient, while you're looking at the patient record. But what happens, if in the case of our practice yesterday, your practice receives a limited number of flu vaccines? Shouldn't your EMR allow you to run a query and find those patients who should receive the vaccine because of existing health reasons such as COPD? Apparently most EMRs on the market wouldn't allow a physician to do that. Ours does. So that's what Dr. Hahn did yesterday. He ran a query to find those patients in the practice with certain health conditions that should prioritize them to receive the flu vaccine and called them up. It took a few minutes.

Compare that to the practice with paper charts. Have you ever seen a medical records room? It's a room with nothing but shelves and shelves, or cabinets and cabinets, of folders containing patient records. Can you imagine going through all those hundreds of records to find 50 patients to receive a vaccine? Would you bother? Probably not. Our EMR allows us to care. And that's what it's all about: a new way to practice old fashioned care.

Announcing Flu Clinic October 10

Hahn and Nelson Family Medicine and Pharmacare would like to announce a community flu clinic at the Hahn and Nelson office on October 10, 2009 from 10 a.m. to 2:00 pm. You do not need to be a patient to participate. Medicare will be billed directly for all Medicare patients; all other insured patients will need to file for reimbursement on their own (Pharmacare will provide you with the necessary paperwork). Please call Hahn and Nelson for other details: (301)678-7007. The cost of the vaccine will be available in early October.

Who should get the flu vaccine? The Centers for Disease Control (CDC) website has some excellent information on how to protect yourself from the flu.

Please note, this is NOT the H1N1 (Swine) flu vaccine. For information on H1N1 vaccine, please consult the CDC website.

Nice story....

I'm not going to moan about insurance companies today, even though it's been months since we started credentialing with Medicare and United and are still not able to bill all of our patient visits with those companies! No, today, I'm going to share with you the story of Jim McCoy and Dr. Hahn. Matt and Jim wrote the story for the American Academy of Family Physician's "Closeup" section in its August publication. I can't link to the story, so I'm going to post it here as a Jpg -- just click on it to make it big enough to read.

We love Jim and Bertha McCoy. I'll never forget the year Matt planned my surprise 50th birthday out at the Troubadour, Jim's famous roadhouse out on Highland Ridge. I didn't suspect a thing, not even when we pulled into the parking lot on a weeknight, to find it full of cars. I was so shocked when I walked in and saw all my friends, and even my mom! that I ran into Bertha's arms and gave her a big hug. I just wanted to hide at first! Since then we've had many wonderful nights of music and friends out there. In fact, we've had so much fun out there that we've decided to have our 20th wedding anniversary party out there later this month. Ya'all come by: it's gonna be fun!