The Insurance Debacle!

Now that it has been 2 months into the practice, I am starting to finally see the insurance payments coming in. Awesome, right?!  Ehhh…

Let me explain this to you and you tell me your thoughts:

Patient X has Medicaid, this patient came in for a well visit, but he also happened to have some ear pain. so doing the reasonable thing, I did the appropriate assessment for the well visit part such as measurements, calculating BMI, checking the child’s vision, assessing him for any developmental problems or behavioral problems and discussing all the details of what is relevant to his age.

Now for the ear pain part of the visit, it’s a different assessment, and he needed a prescription, not only that but he had a lot of wax in his ears, which I went ahead and removed.

At this point all this patient’s issues are addressed.Now comes the billing part:  For insurance claims, one must submit an itemized list of things that were done and hope the insurance will pay for all the work.

In this particle instance, Medicaid decided to pay me only for the ear wax removal $37!!

Apparently I am not allowed to perform multiple “procedures” in one visit. Unfortunately this a game that one has to play to try to get the best reimbursement rates from the insurances. Is it ridiculous?! Abso-freakin-lutely!

What difference does it make if I do the procedures in one day verses have the patient come 3 separate times to get the same done from an insurance stand point?! The work is being done either way! How is having parents miss work and their children miss school repeatedly  reasonable according to the insurance company.

Unfortunately for me, a solo practitioner with my overhead and bills to pay, this type of reimbursement is not sustainable, and I unfortunately have to comply with the way the insurance company is going to pay me. I really hate that I have to do this…

What are your thoughts on the matter?

 

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3 thoughts on “The Insurance Debacle!

  1. It’s one of the most frustrating things to all practices that deal with health insurances specially medicaid..u just have to accept what they pay you and alot of times it doesn’t cover your cost..how fair is that to small business owners?

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