Re: Blues paying 'second procedure' for Postpartum t/l
From: jkulkin-whra (jkulkin@whrassociates.com)
Fri Mar 15 19:39:30 2002
I can think of no justification for the payer to do this. No done through
the same incision, not an incidental procedure. Separate liability for
complications and failure.
Sounds like one for the insurance commissioner or consumer advocates offcie.
JK
Jay M. Kulkin, MD MBA FACOG
Women's Health Resource Associates
3475 Oak Valley Road
Suite 2640
Atlanta, Georgia 30326
404-841-0034
Fax: 404-841-0054
>----- Original Message -----
From: "art fougner, md" <evsono@pipeline.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.medispecialty.com>
Sent: Friday, March 15, 2002 9:11 PM
Subject: Re: Blues paying 'second procedure' for Postpartum t/l
> time for the broken record refrain -
>
> "look for
> the union label ..."
>
> art
>
> At Fri, 15 Mar 2002, Gordon wrote:
> >
> >Kevin,
> >
> >Here is a copy of a previous post.
> >
> >And when patients get a belly full of that kind of crap, maybe then they
> >will become activists in their own behalf!!!
> >Insurance companies will not listen to you or I, but when employers get
> >enough time away from work from valued employees who could have something
> >done as a single procedure and patients are forced to have multiple
> >procedures with concomitant cumulative risks, things may then change.
> >
> >This is already happening in our town, with postpartum tubal ligations.
It
> >is so simple to do it at C/S or even through an inframumbilical incision,
> >with an epidural already in place. But if the payers refuse to reimburse
> >for it, many docs make excuses to patients for not doing it then. And
now,
> >anesthesia has been refusing to redose the epidural for postpartum tubals
> >because they don't get paid for doing it or for the extra length of time
and
> >care for the tubal surgery.
> >
> >--
> >Gordon M. Goldman, M.D., FACOG
> >Private Practice, St. Louis, Mo.
> >
>> >>----- Original Message -----
> >From: "Kevin Dew" <kdew@bellsouth.net>
> >To: "Multiple recipients of list OB-GYN-L"
<ob-gyn-l@mail.medispecialty.com>
> >Sent: Friday, March 15, 2002 4:41 PM
> >Subject: Blues paying "second procedure" for Postpartum t/l
> >
> >> Recently the KY Blues informed we docs that if we do a Postpartum t/l
on
> >the
> >> same calendar day as the vaginal delivery, they will pay us as if it is
a
> >> "second procedure" and not at the "full rate"
> >>
> >> Comments?
> >>
> >> Kevin D. Dew, MD
> >>
>
> --
> art fougner, md
> ich bin ein New Yorker
