Re: Insurance (long)
From: Rafael Haciski (haciski@earthlink.net)
Sat Sep 1 19:37:32 2007
So if a pt comes in for an annual/PAP you will do the PAP, discuss
some preventive issues like breast exams, schedule mammogram,.
suggest/refer for colonoscopy. And that's it.
But if she had a DEXA two months ago and has osteopenia/osteoporosis
then you reschedule her to talk about those issues?
And she also admits to SUI at the time - do you say nothing about
this and reschedule her?
--
Rafael Haciski MD FACOG
Anchor Health Centers GYN
800 Goodlette Rd #360
239-643-8780 office
239-571-0292 cell
Naples, FL.
On Sep 1, 2007, at 10:36 AM, Garry E. Siegel, M.D. wrote:
> FWIW, here's what we TRY to do.
>
> When patients call for an appointment, sometimes they will say to the
> receptionist/scheduler:
>
> "I need my pap and I'm having X problem (pain, AUB, menopausal
> symptoms,
> etc.)." At this point, they are told to make two appointments--usually
> the problem one soon, and the pap later. It usually goes over
> fine, as
> we say that insurance doesn't allow us to do 2 things at one
> visit. We
> don't get any more detailed than that.
>
> When they come in, sometimes they'll ask the medical assistant and/or
> me--"Can't we just do it all today?" Sometimes, there are
> circumstances
> that make that best (they live a long way away, they are self-pay,
> there
> are compelling medical reasons, or they just complain too much and too
> loudly), but usually it is accepted. I tell them directly--"When
> you go
> to the grocery store and buy bread and milk, you pay for both. Your
> annual examination is bread, and your menopausal symptoms are milk,
> and
> many insurers won't pay for both on one day, and we can't call every
> insurer for every patient. We're sorry but we need to get paid for
> what
> we do and keep the lights on." Most accept it.
>
> Another scenario is when people come in for an annual, and, by the
> way,
> I have AUB or I want my IUD out. I generally tell them the same
> story,
> and they generally are accepting of it.
>
> I know that the CPT rules allow various modifiers to allow two
> services
> on one visit, but our experience is that we aren't paid uniformly,
> have
> to appeal, get denied, etc. Maybe we are doing it incorrectly, but
> this
> solution is pretty simple and seems to work for us. Of course, we
> realize that it is NOT convenient for the patients, but my partner
> and I
> feel we have no choice but to maximize our reimbursement given today's
> climate.
>
> Garry
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
