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Re: GEN: How do insurance carriers do this? (long)From: Joanne Bulley, MD (islesannie@yahoo.com)Sun Feb 27 17:38:15 2005
To answer you actual question: NO! If the insurers checked out past procedures and diagnosis codes ... we'd have never gotten paid for either the prenatal care and C/S or the later TL on a patient diagnosed with premature menopause (only one or two slight bleeds after the age of 16 and nothing by 20 ... and seen by REI for the diagnosis). And you are right - if you read the CPT books and go to the classes --- you are supposed to be able to charge for BOTH the preventive and the problem at the same time ... but they 90% of the time only pay what is the lesser of the two. SO we can follow ALL the rules 100% and still not get paid for what we do. But if we don't follow the rules or bend one the tiniest bit ... that is fraud. Who wants to pow wow on a change in the payment system for medical services? .... although I moan and groan about it ... I'd still rather be seeing patients than working on the system ... which is probably just like a lot of you others out there in the US of A .... and so we keep putting up because we don't want to do the work to change it (not to mention feeling totally un-empowered to do anything) Joanne
At Sun, 27 Feb 2005, Garry E. Siegel, M.D. wrote:
>
-- Joanne Bulley, MD Keene, NH, USA
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