My day to vent

This blog is for you, patients and fans, but sometimes I just need to vent, ok? One of my jobs is making sure that Hahn and Nelson Family Medicine gets paid. Usually things go pretty well but today was my day to go through unpaid claims and figure out why we didn't get paid. I have to tell you, Carefirst and Blue Cross Blue Shield patients: your insurance is a big headache for many reasons. But today was a killer.

Maryland just passed a law last year as part of healthcare reform that allows providers to bill insurance companies a small extra charge whenever they see a patient outside of "regular" business hours. Regular business hours are after 6 on weekdays. We see patients until 7 on Tuesdays and Thursdays, and as you know, our doctors will occasionally see patients on the weekends (and even make a house call now and then!). The law was passed partly to encourage providers to see patients in the office rather than have them go to the more expensive emergency room. If you've ever had to go to an ER, you know it's way more expensive than your friendly physician's office, and well, not nearly as friendly.

So we saw a young patient in our office one recent Saturday. We billed the extra $10. Whoopee! Ten dollars doesn't seem like a lot does it, when you consider the provider interrupted his busy Saturday, drove 6 miles to and from the office....? Anyway. Carefirst didn't pay it because this patient is "self-insured" and apparently the law exempts self-insured policies. This made me angry. They didn't *have* to pay it so they didn't. Well, guess what Carefirst? We didn't *have* to see that patient in our office. We could've sent her to the ER, or told her she'd have to wait until Monday to see a doctor. So I wrote a letter to the Senior Vice President. Here's what I said:

M. Bruce Edwards
Senior Vice President, Network Management
Carefirst

We recently filed a claim containing the CPT 99050. It was returned with that part of the claim unpaid. After filing an appeal, we received a letter stating that those patients who had self-paid policies would not be getting that CPT reimbursed, and that it is not required to be reimbursed by law.

Just because you aren't required by law to reimburse this doesn't mean you shouldn't. We are saving your company significant money by not directing our patients to emergency rooms and urgent care facilities after hours. In this case, a young patient was very ill on a Saturday, Instead of the office visit we billed Carefirst, she could've gone to an ER and been billed much more. Furthermore, she would've had to deal with a strange doctor, which is not ideal especially when dealing with a small child. Or, she could've stayed home until Monday and gotten worse.

We are not required by law to provide after-hours services but we choose to do it, in part because it's a symbol of how much we care for our patients. We do this regardless of what kind of insurance our patients have, or even if they have no insurance. It isn't always economically advantageous to do so, especially given that we practice in a rural area. We think it makes us a better practice. We're disappointed in you as an insurer that you don't strive to do the same for us and our patients. 

So there. I got to blow off steam. And by the way, don't worry. This is not a charge we're planning on passing on to our patients if your insurance company decides you're not important enough to pay it. Because you are important enough to us.