12 Jun 2014
June 12, 2014

Billing Issues

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We continue to be dismayed by the complexity of the health care payment system. Increasingly, patients tell us that we have made a billing mistake when in fact there is simply not a way to know ahead of time what is “correct”. Large employers now are usually “self insured” under federal health care law. This means that each large employer sets up the terms and conditions of the policy and then hires an insurance company to be the administrator of the policy. The result is chaos for my billing department.

If we see two patients with two different employers, but the same insurance company X, their benefit packages are different. Some are high deductible, some cover 100% of preventive visits but 80% of illness care. Some cover illness care, but only part of preventive visits. Some don’t pay for blood work unless the patient goes to a particular lab. It is an endless list. It changes every 6 months.

On top of that, we have contracts with the insurance company that let us be paid in certain ways. It is increasingly common for people to ask us to do something a certain way to save them money, and we find that if we do it that way we are not paid at all. During Preventive Visits when we also deal with illness issues there is no way ahead of time to know how to submit the billing so that we get paid and the patient has minimal out of pocket cost.

Please try to be in good humor as we work with you. We are struggling in a crazy payment system that is not of our making and that is intentionally designed to make things difficult so that our payment is prevented or delayed.