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Friday, March 16, 2007

Never say die!

I just received an EOB with a payment for a 99214 from July. July! An 8+ month old claim. It was denied 4 times previously. The first time because the insurer claimed that the ID# was incorrect. We re-submitted the claim and proved that the number we had was correct and that their number was incorrect. We marked 2nd claim on the submittal, onlyto be denied again, this time by, "sorry, that must have been a mistake." We re-submitted claim number #3, which was denied for late filing. After fighting that, because we had proof of our previous attempts, we re-submitted and then were paid, $50.00.

$50 bucks. Was it worth it? Was it worth the hassel? You betch-ya! 50 bucks is 50 bucks is 50 bucks. It's a month of cell phone service. It's a bottle of UA dip-sticks. It is my money, rightfully. Not the insurance companies.

Notice that we never billed the patient, because that would have been wrongful, in my view. The patient had the coverage, we accepted it and did our part for the claims process. The insurer played games and profitted from the delay. Imagine denying 10,000 claims for $50 dollars each for 6 months at a modest 4% return, then ultimately paying the $50 dollars to the 20% of doctors that persisted as we had. By my calculation, an insurer can make an extra $420,000 dollars over a 6 month period. Technically this is not legal, but it can be done, and probably is done "by mistake." In the past this was common practice of some insurers and ultimately cost these carriers millions after a successful law suit filed by the NY State Medical Society. And you know what, it is still done.

It is not your job to subsidize the insurers and your patients already pay enough in premiums. Make the carriers pay what is owed, no matter how small.

Never say die.