Comments for WhiteCoat Rants

Comment on Describing The Pain Scale by Betty

Betty — Thu, 07 Aug 2008 18:21:36 +0000

I have never used a 10 for myself, (2 torn discs in neck, awaiting surgery with a CSF leak). Without meds I have been in such pain I want to tear everything apart, feel intense anger, used as a release. Like a wild animal. When I control my reaction, which I prefer, I am treated with doubt. I always thought of a 10 as having your head sliced of with a butcher knife… and then a doctor described a 10 as something that would make you scream… quite a difference. Been there, done that. Meds makes it a 5 shortly after taking, then a 7 before the next dose. Trying to stop the meds…. howl. I think it would be different according to the number of nerves in the area under assault.

Comment on More Fishing … by rlbates

rlbates — Thu, 07 Aug 2008 17:20:02 +0000

Enjoy yourself, and bring us back some great pictures!

Comment on Rating the Insurers by Marilyn

Marilyn — Thu, 07 Aug 2008 17:05:37 +0000

Helpful information, and very timely for me. Thanks very much.

Wish I could change my insurer which shall herein remain unnamed; it’s provided (well, we pay half the premium) through my husband’s employer and we don’t have other options. After struggling for 3 months to get my CT scan paid for I was wondering if I’m the only one who has trouble with this insurer. The chart linked to this article shows me that my insurer ranks between 16th and 18th of 21 West coast companies on most criteria. I was going to ask my hospital billing office what they think of my insurer, don’t need to now! My husband will be going to his employment office and talking this over with the human resources manager.

Why won’t they pay for the scan? Billing error… they say the scan was ordered as if I had been seen on a standard “office visit”, not an “urgent care” visit (though I did go to the urgent care clinic…perhaps this is related to my insurers extremely poor performance in compliance with national coding standards?). The hospital did not obtain their pre-authorization in 24 hours, as required by insurance. Gee whiz. If I hadn’t been so sick and in so much pain (diverticulitis attack with 101.5 degree temperature) *I* would have called the stupid insurance company. Now I’m in the middle of a fight with the hospital and the insurance company. Hospital wants their money from me and I also have to deal with the associated independent contractors (radiologist, pathologist, etc.) that were denied payment for the same reason. I’m sure glad I didn’t perforate…this could have gotten very ugly!

I am going through the same thing with my colonoscopy. The doc’s office got their pre-authorization and, theoretically, the expected insurance portion. Now I have my EOB from insurer, they have denied half the charge for the procedure. I expect I will probably have to fight to get my mammogram (coming up next week) paid for as well.

I don’t even want to think about how difficult these issues become for someone with more complicated medical issues (or even someone without bookkeeping/billing experience as I have). This is sure a headache.

I’m not in favor of a single-payer (read: government) plan, but I can understand why people think it will make things less complicated.

Comment on Rating the Insurers by crankylitprof

crankylitprof — Thu, 07 Aug 2008 14:30:20 +0000

You mean I can Press-Ganey bomb Keystone healthbastards?

SWEET!

Comment on More Fishing … by ernurse

ernurse — Thu, 07 Aug 2008 12:32:15 +0000

Enjoy the time with your family!

Comment on Rating the Insurers by Marie

Marie — Thu, 07 Aug 2008 11:37:59 +0000

What I will give NY Medicaid credit for is that I don’t have to get pregnant to get some medical help. My state apprently doesn’t give a shit if you’re single.

Comment on Idiocy - Alive and Well in Los Angeles by Samson Isberg

Samson Isberg — Thu, 07 Aug 2008 09:45:49 +0000

Why not rent a hotelroom for, say, 1 night in the patient’s name; and then discharge him to “his room” in said hotel. Pay for 1 night and 1 night only, come next day it will be the hotel staff that kicks him out to the gutter.

And they are allowed to do that, right?

Comment on Why Is It … ? by August 7 roundup

August 7 roundup — Thu, 07 Aug 2008 05:13:37 +0000

[...] More thoughts about “going on disability” [White Coat Rants] [...]

Comment on Rating the Insurers by TK

TK — Thu, 07 Aug 2008 02:57:11 +0000

Wait a sec, will these “Press Ganey” type scores for insurance companies change their reimbursement like it does ours?@!?!??!?

Comment on Rating the Insurers by mottsapplesauce

mottsapplesauce — Thu, 07 Aug 2008 00:41:35 +0000

Totally agree SeaSpray. Billing & processing claims is not an easy task. One young woman I spoke with, who works for the Public Welfare Dept in Pennsylvania, said you practically have to be a rocket scientist just to figure out the prior authorization process. Claims are another story.
With regards to United Healthgroup, I saw firsthand how awful their reimbursements were, & how long it took for our physicians to get paid–or any other provider to be paid.
A couple years back, a very large commercial insurance carrier, which I’m sorry will remain nameless, was cutting so much from their reimbursements, that the policyholders & their employers were dropping contracts like hot potatoes & seeking other carriers. Needless to say, to win some clients back, this carrier had no choice but to raise it’s fee schedules just to remain competetive.
I submit high-dollar claims & you wouldn’t believe the excuses I’ve heard for lack of claim payment. Very little are legit, the majority are stall tactics. Diligent follow up is the only way I can get them paid.