United, more.

Yep. I am seriously going to consider shopping around for insurance... I currently carry United, and now I'm wondering: why am I paying these people $600 a month?

• They are living proof of why we need a public plan. Why can the government afford to pay us more than they do?
• They denied a claim of Willa's because her problem occurred within 6 months of buying the policy. Too bad for her. She should've waited to get sick!
• They refuse to realize that we do not participate in their capitated plan: which means I have a small pile of rejected claims. Each of these takes approximately 20 minutes on the phone. I've spoken to the provider representative at least twice, and called about each mis-calculated claim to the claims department.
• See my previous insurance rant.
• Now I've been on the phone for 20 minutes for an $88 claim that was rejected because, supposedly, the member's plan "does not cover this visit, consultation, evaluation and management." I was able to find the member online on United's website (which is actually, surprisingly, quite good.) and find that her coverage is 100%. But, I couldn't find her claim status anywhere. So I reluctantly picked up the phone. The phone number on the top of the EOB was, I find out after sifting through the voice response system, only for customers. I was connected to the provider number and got a very nice young man who could, after awhile, finally pull up my patient. But he couldn't find any claims matching the one that we have that was rejected. He looked and looked -- we used every number on the EOB that could conceivably be used to retrieve a patient's records. Nothing. He put me on hold. He looked some more. Finally he decided to transfer me to a "claims specialist" who he was sure would be able to resolve the problem. I sat on hold for about 2 minutes, and then -- I was disconnected.

Ooooof. So now what do I do? Is it worth $88 to start all over again? Do they want me to just forget it, and maybe bill the patient?

Let me state here that every single person I've talked to at United Healthcare has been very nice. I have nothing against them personally. But they need to do something about this mess they call "healthcare."

1000 strong! AND H1N1 vaccine is HERE!

11/5/2009 5:05 pm: Hahn and Nelson Family Medicine, after being open for barely four months, registered our 1000th patient! We can't reveal the name of the patient because of HIPAA regulations, but let's just say she was happy to receive the bouquet of beautiful flowers that were presented to her.

We'd like to say right now that every single one of our patients is special to us, no matter when we registered you. We love and care for you all.

Actually, we care about everyone regardless of patient status. In fact, we're getting a shipment of H1N1 vaccine that we are happy to administer to anyone in the community. We prefer that you meet the criteria specified by the CDC and preference will be given to those who meet it. Just call us at 301-678-7007 or email us at hnfm @ verizon.net (you'll have to type this into your email software -- we're not linking to it because of spammers) to make sure we have some left and to find out the best time to stop by. We will be charging a small $10 fee to administer the vaccine -  the vaccine itself is free. You will need to fill out a form.

OK, that's enough good news for now! Stay healthy.

Ode to the Front Desk Staff

Next time you go to your doctor's office, take a really close look at the people sitting behind the desk. They probably appear fairly calm, although they may be surrounded by paperwork, ringing phones, and a computer demanding that they click something.  I never really thought much about what goes on there until this week. Robin is this minute somewhere on a cruise ship, probably enjoying one of those round-the-clock buffets and endless fancy drinks, while I've been attempting to fill in for her and help Lindy run the front office.
Monday could best be compared to sitting in a room with 5 tiny babies. As soon as one of them goes to sleep, another starts to cry. As you pick up the crying baby, another one needs its diaper changed, and another one rolls off of the changing table. It goes like this: The phone is ringing, sometimes 2 or 3 lines at once. Someone is waiting to check in and pay a co-pay, someone else is waiting after their appointment to schedule another appointment. Then, just as you think it's quieting down, someone walks in and wants to register as a new patient.  Or one of the doctors needs to be shown how to do something on the computer, or asks you to make a phone call.
I'm used to working in the back office, calling insurance companies about claim denials, posting payments (when we're lucky enough to get a check!), calling patients with appointment reminders, creating billing statements, and lots of other little tasks. I enjoy working on one thing at a time, with occasional breaks to stretch my achy neck. Working up front was a shock to this extremely introverted soul!
I tried to recall any time when either Lindy or Robin had seemed overwhelmed, cross, or even mildly upset. I wasn't able to summon up one negative peep out of either one of them! As I cruised through my mental image library, all I could see were two calm, usually smiling faces, talking gently to patients, answering the phone professionally and politely. How do they do it?
I think it's because they genuinely care about doing a great job, and because they really love our patients.  I hope it's also because they've found a place where they feel valued and like they're making a difference. Because they are.

I blog so I do not scream.

It might frighten the patients.

United Healthcare is right now on the top of my sh*t list. This is terrible, because they are currently my insurance company (but if I can help it, not for long). First of all: they pay doctors terribly. There is at least one Medical Assistance payer that pays better than they do. Then, they can't seem to get anything right. I keep getting back EOBs (Explanation of Benefits, to those of you fortunate enough to  not know) that claim we have a capitation agreement, meaning the insurer is supposedly paying us a monthly fee to care for their patients instead of paying a fee for service. We do not. So I have to call them, spend at least 10 minutes on the phone waiting for the insane Muzack to just STOP already and have someone pick up the phone.

This morning I got back an EOB with the capitation problem. I called United, punched in the numbers for the patient and our providers, got put on hold for about 10 minutes and finally got "helped" by a representative that claimed he couldn't help me because my patient's policy was held by a different group. I protested, saying that the patient's card had this phone number to call, as well a the EOB. He didn't cave, and gave me another number to call.

I called the number.... on hold for 5 minutes this time. Really bad Muzack, couldn't even tell what genre it was supposed to be ruining. Now I'm told that my patient must have an outdated card; the representative can't even look up my patient. I decide to call back the original United number I have, since I was able to get claim information using the automated system.  So, after being on hold for 15 minutes, someone answers, takes all my patient's information and our provider's information and told that I don't have the claims department and get transferred. After being on hold for another 10 minutes, the call is answered by someone with a very strong accent who sounds like she's talking underwater..... but I finally gathered that she was also the wrong department... this after she took all my patient's information as well as our provider's. I have now been on the phone for 30 minutes with no results. This for a charge of $118, which United, if we're lucky, will end up paying $60. Seriously.

OK. I've got someone on here who speaks English and I can actually hear her. I've given her my patient information. She can resolve the issue of the capitation but not why we're not getting paid for the office visit and just the procedure we did. So an initial charge of $118 will probably end up getting paid $30 if we're lucky. People with United HealthCare, your insurance company stinks!

If we had a single-payer system, I would be able to always call the same phone number, enter the same kind of information each time, and get help. I would be able to type the same kinds of numbers on my telephone's keypad. My providers would have one set of ID numbers instead of 15. We would only need to credential with one entity instead of 13 or 14. I would only have to access one website to get claims and benefit information. Robyn and Lindy would only need one access point to make referrals and get benefit information....Medical students could graduate and open their own little offices like ours without having to have an entire team of billing specialists to worry about all this stuff.... Dream on.

Flu/Pnemonia clinic

Hahn and Nelson Family Medicine and Pharmacare/Optioncare administered approximately 100 seasonal flu vaccines on Saturday October 10. A number of pneumonia vaccines were administered as well. If you were unable to attend our flu vaccine clinic and you still want a vaccine, Pharmacare has several additional clinics coming up. You should call to make sure the clinic is still scheduled, as the seasonal flu vaccine is in short supply.

Laughter is the best medicine

...and we can serve that up, too, apparently! It's good to know that your doctor has a good sense of humor, right!?

Dr. Nelson to be Guest Speaker at Breast Cancer Awareness Day

Make some time for yourselves this Monday, ladies. Come to War Memorial Hospital in Berkeley Springs at Noon on Monday, October 5 for a light lunch and find out the latest on breast cancer screening guidelines from Dr. Marilyn Nelson. The lunch and talk are sponsored by the Morgan County Community Educational Outreach Service, the Morgan County Health Department, and the Morgan County War Memorial Hospital. Everyone is welcome!