Monday, August 26, 2024

Referrals

Dr. Oldasdirt is an internist across the street. He takes every managed care insurance known to man.

Occasionally one of his patients needs a neurologist and is referred to me. That's fine, it's my job.

The managed care patients he sees generally need a referral to see a specialist. This is pretty common in American medicine, and has been since at least the late 80's. A form shows up on the fax machine saying something like "AUTHORIZED: patient Kris Kringle, DOB: 8-17-29. National Illness Insurance HMO plan. 4 visits. To see Ibee Grumpy, neurology, for Rangifer's disease."

So Mary files it. A few days later, when Mr. Kringle calls to see if we got the referral she looks it up, says "yes" and schedules him. When we send in a bill for his visit we have to include the referral to make sure we get paid.

About 3 months ago one of his referrals showed up before Mary got in, so I pulled it off the fax. I was about to put it in her filing book when I noticed something different about it.

At the bottom it said: "Only valid for CPT level 2."

To explain this, medical office visits are billed by CPT codes, ranges 1-5, with 1 paying the least and 5 paying the most. The difference is based on how complex the case is, how much time you spend with the patient, what percentage of that time is spent talking vs. doing an exam, whether you're seeing them on a day that does or doesn't end in a "Y," if Mercury is in retrograde, etc. For the record, there are more than 10,000 CPT codes for different stuff,  but I'm just talking about office visits.

I began digging through Mary's file. No referral from any other doctor with that insurance had such a qualifier. It looks like the ones from Dr. Oldasdirt had started including the line about a week previously - fortunately I hadn't seen any of those patients yet.

Basically, what Dr. OldasDirt (or his office staff) were doing was putting a cap on how much I could get paid for the visit, no matter how much time I spent or how complicated the patient was. A level 2 new patient CPT code applies to visits between 15-29 minutes, and (as of 2024) pays a whopping $71. So that's what I get whether they take up 15 minutes or 90 minutes.

This isn't, at least to me, acceptable. Basically I'm agreeing to a set fee, without even knowing why the patient is coming in. Yeah, they could be simple, like carpal tunnel syndrome, but not likely in my field. You think you can take a history, examine, and explain to grandpa and his 7 person entourage what Alzheimer's means in 29 minutes? Good luck. The alternative is to have an alarm go off at 29 minutes, and say "Times up!" & leave the room.

Try calling Target and saying "can I buy any item in the store for $5, in advance, without you knowing what I'm getting until I check out?" I'm pretty sure they're not going to play.

So Mary called Dr. Oldasdirt's office and asked for a new referral without that line. She was told no, that was their new procedure, and if we didn't like it they'd stop sending me patients. With my approval she said okay, and shredded the referrals from them.

If they can find a neurologist desperate enough to work under that condition, more power to them.

Some out there are going to say I'm just here for the money, and don't give a damn about those patients. Whatever. The truth is that I'm here for the patients. This job is what I love. But I also have to pay both of my awesome staff their salaries, and my rent, and all the other overhead items. Not to mention my own mortgage, utility bills, kids college tuition, and so on. I can't help any patient if I can't keep my office open.

Why is Dr. Oldasdirt doing this? I have no idea. Other doctors haven't sent patients from the same insurance to me with that limitation, so I doubt it's the plan. Maybe he was hoping I'd start refusing to see his patients for whatever reason. Maybe the insurance is secretly letting him pocket the difference as a kickback.

I don't know, probably never will.

Monday, August 19, 2024

Resistance is futile

Dr. Grumpy: "So let's work on that MRI... What dates, or days of the week, work best for you to have the study?

Ms. Dixon: I'm not sure yet, I need to make a call."

Dr. Grumpy: "That's fine, just call back after you know what days work with your job to get this done."

Ms. Dixon: "Actually, I need to call my astrologer."

Dr. Grumpy: "Your astrologer..."

Ms. Dixon: "I don't want to have it done at a time when the planets are in the wrong position to affect the results, you know what I mean?"

Dr. Grumpy: "Uh..."

Ms. Dixon: "I mean, if Mercury is in retrograde that can screw up the machine's magnetic field, right?"

Dr. Grumpy: "Actually..."

Ms. Dixon: "She knows a lot about this stuff, she went to a special school or something like that."

Monday, August 12, 2024

Annie's desk

Phone person #1: "Thank you for calling Low-Cost Radiology, where our prices reflect our quality every day! Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #1: "What's a tax ID number? Is it how much we paid in taxes? Last year I paid..."

Annie: "No, it's the number your facility is assigned for tax and business purposes. The insurance companies need it so they can pay you for the MRI."

Phone person #1: "Is that the same as my social security number? I can give you that. It's 738..."

Annie: "No. It's the assigned..."

Phone person #1: "Let me transfer you."

 

On hold with a subdued piano & cello version of "Smells Like Teen Spirit."

 

Phone person #2: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #2: "Hmmm... Is that the number you just called to reach us?"

Annie: "No, that's your phone number. It's..."

Phone person #2: "Oh, is that like a special number the IRS calls us on?"

Annie: "No it's..."

Phone person #2: "Let me transfer you."

 

On hold with a subdued piano & cello version of "Safety Dance."

 

Phone person #3: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #3: "I don't think we have one."

Annie: "No, you do, every business has one, it's assigned to you before you open by the..."

Phone person #3: "Let me transfer you." 


On hold with a subdued piano & cello version of "Paint It Black."

 

Phone person #4: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #4: "Oh, hang on. Let me look that up for you. Hmmm. I thought I had it on a Post-It note somewhere... maybe it's behind the take-out menu for Blumenthal's Chinese... no, maybe it got stuck to the menu for the place we ordered lunch from on Monday, I can't remember the name though... that may be over by the fax machine with the Chipotle forms, hang on... you know, I may have accidentally thrown it out because a bunch of stuff got marinara sauce on it when I was eating yesterday... let me transfer you."

 

On hold with a subdued piano & cello version of "Girls Just Wanna Have Fun."

 

Phone person #5: "Thank you for holding. Can I help you?"

Annie: "Hi, this is Annie, at Dr. Grumpy's office. I'm trying to get insurance approval for a patient to have an MRI there, and to submit the form I need your facility's tax ID number."

Phone person #5: "I hate you phishing scams. Fuck off."

click

Monday, August 5, 2024

Current status

Sir, if you don't stop tapping "Rock Lobster" out on my desk with your horribly untrimmed fingernails I am going to have to kill you with a Trömner.