Friday, December 30, 2011

Games I'm not playing

Dr. Grumpy: "Okay, I'll put in the MRI order. It will take 1-2 weeks to get authorization from your insurance, then Annie will call you to schedule the test."

Mr. Oig: "Can you do it today? My insurance changes on the first."

Dr. Grumpy: "No, I'm sorry, it takes 1-2 weeks for routine studies."

Mr. Oig: "My co-pay goes from $75 for an MRI to $100."

Dr. Grumpy: "I understand, but it takes 1-2 weeks to even get it covered."

Mr. Oig: "Why don't you just order it STAT and say it's a medical emergency? You and I both know that will get it covered."

Dr. Grumpy: "But it's not an emergency. You've had these symptoms for over 2 years."

Mr. Oig: "So what? It's not a big deal."

Dr. Grumpy: "It's insurance fraud."

Mr. Oig: "Well, if you're not going to order it as STAT, then you better be willing to spot me the $25 difference."

Dr. Grumpy: "I'm not going to do that."

Mr. Oig: "Fine. Then I'm just going to find an ER that will." (leaves)

22 comments:

aek said...

Oy vey! Good on you for not caving to his threats.

On the flip side, I think that the date of the dx imaging order and not the actual date of service should be the one that triggers the cost, be it self pay, co-pay, deductible, etc. I sympathize with people who have to endure (many times, very long) waits for prescribed services and then have to foot higher costs as a direct result of that wait. (I've been there and had to cancel or forego because I couldn't afford the higher fee.)

That issue should never enter into the MDs considerations in formulating the plan of care, but it does quite frequently in that patients are increasingly unable to afford prescribed care, meds, treatments, etc.

Thatgirl said...

Meanwhile on some ER nurse's blog there will be a post about some jerk who came in for a 2 year old "emergency" condidtion. His expenses could have been specialist copay + MRI copay of 100 but now it is specialist copay + ER copay with a chance of not even getting the MRI until next year anyway + whatever his MRI copay will be, just to save the $25 difference...

Garrick said...

It's times like these that I wish there were exceptions in HIPAA or Dr./Patient Confidentiality that would allow you to submit a recording of this visit to this gentleman's insurance company so that they are aware of it. I have no idea where you are or how big the area is, but a quick friendly call to area hospital ER imaging units might be warranted.

This is why insurance costs keep going up.

Anonymous said...

OIG for federal crimes. The insurance company will send in Chester Purkey.

Anonymous said...

kudos, grumpy

History Doc said...

Two weeks for an MRI? Really? No wonder patients want to commit insurance fraud.

Anonymous said...

Two weeks for a non-emergeny condition? Sounds not too bad, plus it gives you enough time to get off work.

Anonymous said...

And the scary thing (or perhaps, disappointing) is that Mr. Oig will find someone/somewhere to get the MRI done following his "agenda!"

Wishing the Grumpy Family (and all the BLOG readers) a Happy, Healthy, 2012! And if I could request that Winter remain the way it is, everyday, for the remainder of the season, I would be very happy. I don't need to see "the four seasons," unless they don't include snow. NO SNOW, NO SNOW, NO SNOW and if that isn't clear enough........NO F&*#ING SNOW, PLEASE?

Take care!

Anonymous said...

Good call. There were eleven months other than December in 2011. As the saying goes, a total lack of planning on your part, does not constitute an emergency on my part. The key term is lead time.

OldSquid said...

Most ER co-pays are $100

Anonymous said...

im sorry but that is ridiculous. why do people even have insurances if they still have to pay a load of money? isn't the whole point of being insured that you have everything covered?

Anonymous said...

I do not feel an iota of sympathy for the 'personhood' of the insurance corporation with us thinking it's fraud that we have manipulate date. I am so glad that I am not in the lawyer/liar business...what is the 'intent'? Anyway? Is the MRI necessary, or what? If it's necessary, then do it. If not, then tell the patient so!!

Anonymous said...

I am an emerg doc and I am 100% sure that there is absolutely no way an MRI would get done the same day for a non-emergent condition no matter how much the patient tried to bully the doc. Of course, up here in Canada, things are much more rational - my jaw is really on the floor sometimes from reading the patients and situations you describe in your blog!

Technically Insane said...

Insurance Fraud vs. $25. Some people just dont get it!

myoclonicjerk said...

*Sigh*

Anonymous said...

Anon 6:05am: The point of insurance is to protect against catastrophic medical expenses, not pay for everything. Do you demand that your car insurance company pay for you to get a new car just because you pay your premiums? No. You pay them so that IF you have an accident, you don't have the burden of replacing the car yourself (especially if you're still paying off the wrecked one).

Frantic Pharmacist said...

Way to stand strong, Dr. Grumpy. We are with ya!

UK person said...

Anon 6:05am: Your car insurance has an out of pocket Excess doesn't it? Same thing!

prisoneroftoday said...

I can't stand selfish little pr!cks like this. 2 bloody weeks for something that is not an emergency, and he thinks that's too long? Geez. $100 for an MRI, isn't it a few thousand without insurance? I certainly wouldn't complain about that.
...2 friggin weeks *grumble* if he thinks that's too long, I'd love to hear what he thinks of how long I've been waiting (6 months, no appointment yet. That's fine though cause there are others that need it more first).
Bloody con artist. I wouldn't be surprised if he opens packages in shops then demands a discount on the product because someone opened it too!

Anonymous said...

Anon 7:33pm: your example is like if health insurance paid for new boobs and i don't know what kind of plan you have but mine doesn't cover that kind of thing. plus i think 100 dollars is a lot of money and you shouldn't have to pay that kind of money for something as essential as health. and UK person, cars are luxury, so different thing.

Anonymous said...

MRI without insurance around here is over a 1000 bucks. $100 is a cheap copay.

Anonymous said...

as an HR manager, this is why I love our HDHP plan...it gives our employees a glimpse of what things REALLY cost before it starts picking up the tab. I think co-pays should always be expressed as a percentage of the cost, for the same reason. I know lots of folks with low-co-pays who have their doctor prescribe normal OTC drugs, just because their $2 co-pay is cheaper than the $8 they'd pay OTC. (so, about $150 insurance cost of dr visit and rx drug to save $4 of patient money).

at Anon 6:05 - it's not the insurance company you hurt, it's your fellow human beings. Insurance company just increases the premiums, which either gets pushed back to insured people, or causes the company to drop/reduce insurance further.

The idiot in this insurance had this condition for YEARS, and only decided to do something when he realized he'd have to pay $25 more if he wanted to do it in the future instead of immediately. Now, he's willing to waste THOUSANDS of dollars to get his way.

 
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