Re: GEN: How do insurance carriers do this? (long)
From: art fougner, md (evsono@pipeline.com)
Mon Feb 28 05:47:02 2005
Anyone feel a Howard Beale moment coming on?
art
At Sun, 27 Feb 2005, Joanne Bulley, MD wrote:
>
>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:
>>
>>Does anyone out there (lurkers, people associated with carriers) have
>>any idea of how it works, i.e my original post?
>>
>>Garry
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
--
art fougner, md
"If you don't know where you are going, you will wind up somewhere else."
Lawrence Peter Berra
