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The entire problem is not the health care act, but the insurance billing systems in general. The health care act has only exaggerated an already existing problem.
About 10 years ago I had a corner of a molar break off near a large filling. There was decay beneath the filling and the dentist told me that I would need a crown in the near future. I did not have the money for that and asked if he could just put in a new filling for the time being and i would come back for a crown at a later date. he agreed that it was not so time sensitive that a fews months or even a year would be a problem.
The office manager came in to go over the costs before we proceeded and told me that the dentist was going to be doing a buildup on that tooth and my portion of the bill would be over $350. My insurance would pay 100% of a filling, but only 40% of crown related work which a buildup is considered.
I asked the dentist, when he came back in, what the difference was between a buildup and a filling and why we could not do the filling as discussed earlier. He responded that they were the same thing. The work involved was exactly the same and it was just the office billing procedure to code it as a buildup to make the crown work easier to track. i explained that his office convenience was going to cost me an extra $350+ and would prefer they code it as a filling. He agreed with my reasoning and told the office manager to change the billing code. She was not happy, but my wallet was.
Many of the activities by doctors can be categorized by different billing codes, depending on how they got to that point in treatment. I always tell my doctor that I am there for a preventative checkup and proceed to fill them in on my past and present issues. I want them to be aware of my condition when they perform their checkup, but make it clear that this is a routine preventative visit and NOT a illness prompted visit. Most of my personel issues are chronic care type issues and as such my prescriptions fall into a different category, but the office visit coding is critical to keep my costs down.
I have had visits where the staff want to code the visit as a chronic care maintenance visit and I insist that it is a wellness check because the insurance company treats a maintenance visit as a illness based visit and it costs much more even if the diagnostic and treatment results are the same.
Thank you Johnrex. That was my point that it has been this way for a very long time, but also agree that the new ACA law has created a new set of challenges for the insurance companies to try and circumvent, and I will agree any ambiguous language written in the law of 2000 pages will be used to the fullest extent by the insurance companies, and even some doctors to their advantage. But these silly ambiguous coding's along with their differential meanings, are purely the work of the insurance companies and can often be used to the detriment of the patient.
Also a fact: As far as misapplied coding's which render higher costs, this is usually not an issue when paid for by the insurance company, whether it be hospital or doctor's charges. It is only when people have to pony up the money themselves, they take notice. Also the continued push by the insurance companies for higher and higher deductibles over the years has been a big factor (experienced mostly by independents having to purchase individual policies) See this interview aired before the passage of the ACA. http://www.pbs.org/moyers/journal/07102009/watch2.html
Last edited by modhatter; 08-13-2014 at 01:44 PM..
Billing codes and ICD 9 CODES. Although the new ICD 10 codes will be coming soon. Add G codes to Medicare patients too.
Got to keep the pencil pushers employed.Especially the GOVT pencil pushers who mandated all of this nonsense. Sometimes I spend more time writting my ACA required electronic medical record note than I spend working on my patient.
This has turned too political instead of a health insurance driven issue. I have never said that only one party is influenced by corporate money. They both are, of course. Much legislation is written by lobbyists and not politicians. What we have going on in Washington now is shameful and corrupt beyond words.
How can any of us effect change, when they are so successful in keeping us separated by ideologies that many of them don't even believe themselves. It's nothing but a sham being played on Americans to keep their own base stirred up and secure money and votes for the next election.
The Hatfields and the McCoys at it's best.
As far as your post above. I expect Medicare to start changing codes and try and cut back from covering more things as time goes on due to budget constraints. Up until now, with the exception of home health care (your specialty) medicare has always been good at paying claims. If there were any qualms or charge backs, it was usually to the provider and not the patient. How long it can stay this way no one knows. But since the old are the most vulnerable both medically and often times financially, it can be very frightening.
P.S. Funny comment Meemur. Gave me a a good chuckle.
Last edited by modhatter; 08-13-2014 at 03:51 PM..
The next new thing may be even scarier: ACOs. They are a transition towards a health system being paid a set amount per month per patient regardless of care given. Hospitals, doctors, private companies, and even insurance companies can start ACOs.
The financial incentive will be NOT to treat with full support of the govt.
Notice the trend? Now insurance companies get premiums paid directly to them for the subsidized with just covering a few "free" things. Eventually the ACOs will be paid a set monthly amount to do nothing. Pretty sweet deal, huh?
The next new thing may be even scarier: ACOs. They are a transition towards a health system being paid a set amount per month per patient regardless of care given. Hospitals, doctors, private companies, and even insurance companies can start ACOs.
The financial incentive will be NOT to treat with full support of the govt.
Notice the trend? Now insurance companies get premiums paid directly to them for the subsidized with just covering a few "free" things. Eventually the ACOs will be paid a set monthly amount to do nothing. Pretty sweet deal, huh?
As a doctor, I look forward to this. As a government employee, I can finally use phrases like "I'm on break" and "not my problem". It will be just like the post office. And folks better hope they don't get sick after 4:30pm because I have no further incentive to come in and see them. You can have my time or my money, the public has chosen.
As a doctor, I look forward to this. As a government employee, I can finally use phrases like "I'm on break" and "not my problem". It will be just like the post office. And folks better hope they don't get sick after 4:30pm because I have no further incentive to come in and see them. You can have my time or my money, the public has chosen.
If this is your attitude, be prepared to be paid like a government employee like at the post office instead of holding down one of the 10 top paying jobs in the United States where the medical profession takes 8 of the top 10 positions.
If this is your attitude, be prepared to be paid like a government employee like at the post office instead of holding down one of the 10 top paying jobs in the United States where the medical profession takes 8 of the top 10 positions.
That's my point, it's already happening but in the reverse order you describe. Doctors are already taking pay cuts every year from Medicare/Medicaid/Insurance and have been for many years. We will not get pay cuts because we don't work as hard....we will not work as hard because we are getting pay cuts. Would you? Again, you can have my time or my money, you cannot have both.
That's my point, it's already happening but in the reverse order you describe. Doctors are already taking pay cuts every year from Medicare/Medicaid/Insurance and have been for many years. We will not get pay cuts because we don't work as hard....we will not work as hard because we are getting pay cuts. Would you? Again, you can have my time or my money, you cannot have both.
Don't confuse the issue, on this list doctors and dentists hold the top two spots: Doctors And Surgeons - AskMen
On this list doctors hold the top 9 spots: The 10 Highest-Paid Jobs in America - US News
I could go on and on on this same issue.
So you are making FAR MORE than anyone else and now looking at making some less but still more than anyone else and you are whining and threatening that you are not going to work as hard anymore?? No wonder doctors are losing respect Moderator cut: personal - off topic
No matter what you need to know just what insurance covers and is provider with in any network if its not emergency anything. Only way to know is call or better yet e-mail to get written answer. Or better yet have doctor submit plan of treatment for physical and get pre-cleared by insurance with is normal for non-emergency services. now days.
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