This is from EC, an MD in CA
1. insurance company sends me back an EOB stating 'we can't pay you because this pt may have another insurance policy in addition to ours. we need to clarify.' I have seen this pt and his family before, have been paid by same insurance for him for other visits. when I call the insurance company, they say 'will need written letter from family stating they have no other insurance before we can reconsider. No guarantees'
2. Aetna phone line is impossible. BCBS better. I call here from CA at 3:10 pm. You go thru all this garbage pushing codes you don't need, no option to speak to human, then 20 mins later they tell you their office hrs are 8-5pm then it hangs up. I figured it must be the time change, so i call next morning at 7 am before work...go thru the same 20min of garbage then they tell me they are closed until 8 am. They must close eastern or central time and open pacific time.
Incredible.
So fist call- machine says a check for $57 has been issued for that date of service. great- I wait no check comes. I call back 1 mos later, clerk says I can't get paid because I did a procedure for pt the same day or some one did, and can't get paid for both. Of course I did not do any procedure. They check their computers and say 'you are right she did not have any procedure for 30d before or after date of service, Aetna can make mistakes too.
They ask me to be understanding. So now I get a letter stating I can't bill for this office visit because I am a radiologist!!! So again after 3 trials to get thru on the impossible phone line, I tell the woman I have a letter from them stating I am primary care dated jun 09. She says they will need to look into it. It will take another 10 business days to clarify.
Do you believe this? Anyway, for this same pt, I am likely going to get paid about $50-60, half to overhead, so I am trying to get $25-30 for 5 hrs of my time wasted on telephone, plus the visit! I have basically taken a loss on this.
Anyone else heard of better excuses not to pay out for honest work done? Should be illegal. Should be in next health care bill, if insurance treats people like this, they should incur a fine or penalty of some sort. They need to pay claims in a timely manner.
2. Aetna phone line is impossible. BCBS better. I call here from CA at 3:10 pm. You go thru all this garbage pushing codes you don't need, no option to speak to human, then 20 mins later they tell you their office hrs are 8-5pm then it hangs up. I figured it must be the time change, so i call next morning at 7 am before work...go thru the same 20min of garbage then they tell me they are closed until 8 am. They must close eastern or central time and open pacific time.
Incredible.
So fist call- machine says a check for $57 has been issued for that date of service. great- I wait no check comes. I call back 1 mos later, clerk says I can't get paid because I did a procedure for pt the same day or some one did, and can't get paid for both. Of course I did not do any procedure. They check their computers and say 'you are right she did not have any procedure for 30d before or after date of service, Aetna can make mistakes too.
They ask me to be understanding. So now I get a letter stating I can't bill for this office visit because I am a radiologist!!! So again after 3 trials to get thru on the impossible phone line, I tell the woman I have a letter from them stating I am primary care dated jun 09. She says they will need to look into it. It will take another 10 business days to clarify.
Do you believe this? Anyway, for this same pt, I am likely going to get paid about $50-60, half to overhead, so I am trying to get $25-30 for 5 hrs of my time wasted on telephone, plus the visit! I have basically taken a loss on this.
Anyone else heard of better excuses not to pay out for honest work done? Should be illegal. Should be in next health care bill, if insurance treats people like this, they should incur a fine or penalty of some sort. They need to pay claims in a timely manner.
Did you ever pay for a meal in a restaurant? You show them your meal insurance card, and they tell you what entrees you can have, and what the exclusions are, and after the meal you pay them $10 and they apply to your meal insurance, which typically takes a month or two to pay. Sound familiar? No? That's not how your local restaurants do it? What! They get paid with a 1.5% overhead cost? That's impossible.
No, that's common sense. We could boost the net pay for primary care (by $68,000/yr) without spending another dime and improve care by requiring all insurances, including MCR & MCD, to pay for primary care services at the time of service with a debit card.
If the insurance wants to question what you did, they're welcome to ask the patient, or send someone to your office to check.
Posted by: Peterl | October 13, 2010 at 01:48 PM