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Re: Insurance (long)From: rmodugno@aol.comSat Sep 1 20:45:14 2007
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 thereceptionist/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--usuallythe problem one soon, and the pap later. It usually goes over fine, aswe say that insurance doesn't allow us to do 2 things at one visit. Wedon't get any more detailed than that. When they come in, sometimes they'll ask the medical assistant and/orme--"Can't we just do it all today?" Sometimes, there are circumstancesthat make that best (they live a long way away, they are self-pay, thereare compelling medical reasons, or they just complain too much and tooloudly), but usually it is accepted. I tell them directly--"When you goto the grocery store and buy bread and milk, you pay for both. Yourannual examination is bread, and your menopausal symptoms are milk, andmany insurers won't pay for both on one day, and we can't call everyinsurer for every patient. We're sorry but we need to get paid for whatwe 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 serviceson one visit, but our experience is that we aren't paid uniformly, haveto appeal, get denied, etc. Maybe we are doing it incorrectly, but thissolution is pretty simple and seems to work for us. Of course, werealize that it is NOT convenient for the patients, but my partner and Ifeel we have no choice but to maximize our reimbursement given today'sclimate. Garry --Garry E. Siegel, M.D.Private PracticeRoswell, GA *********************************** In my experience, most patients never say they have problems when they schedule an annual exam. In fact - it is probably the problem that has motivated them to come in for their "annual". You are correct about the modifiers - and that's what they are there for if you spend time discussing their SUI or other problems - denials are a pain in the ass, but that's part of the game we are forced to play, and so we have to appeal them. You say "most' people accept this - well, you are lucky - that most of your patients have the time/patience/money to schedule another visit.. I must assume that the ones who don't will "vote with their feet". Times are tough - we all are going through the same thing - but you have to make up your mind whether your practice is "patient-centered" or "physician-centered". :+) Regards, Robert Modugno MD MBA FACOG Sylva, NC = =0
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