Tuesday, September 8, 2009

Insurance morass

Back from vacation! Springing into Fall!

Although it was never my intention to use my blog as a way to complain, I saw Julie and Julia last night and Amy Adams' blogging inspired me to share a story that is only a thinly veiled gripe.

In these times of debate about health care, I have been struggling with the idea of joining insurance plans to make myself more accessible to a wider range of patients than I can see otherwise. In addition to the New York State plan for low income families and children (Child Health Plus), I have been on the Aetna panel for over a year. About nine months ago I decided to apply for four other plans in the hopes that their reimbursements would be reasonable enough to sustain my practice.

The way the application process works is the doctor applies (many documents, reams of paper, phone calls) and time goes by. We did that in January. Eight months later (this July) Blue Cross sent a letter announcing my acceptance. At this stage (and not until then)an applicant is able to know what the reimbursement schedule will be. So, once I saw the numbers ($52.16 for a thirty minute visit; $63.84 for forty-five minutes) and did the math, I decided not to join. HOWEVER, Blue Cross put me on their roster without my approval and listed me on their website in August.

So what difference does it make? The problem is that patients who may be on Blue Cross now submit their superbills from my office to Blue Cross and are told that they only owe me the co-pay because from the company's point of view I am a BC provider. So now, I am struggling to try to get someone to answer the phone at Blue Cross and cancel my listing which I never authorized in the first place.

This one tiny example serves to demonstrate the monolithic, bureaucratic, and confusing nature of the insurance system we work under.

I honestly wish for Blue Cross employees that they find meaningful work one day. Work that does not involve arguing with doctors' offices; refusing care to patients; nitpicking over whether a doctor asked ten questions or twelve; denying claims for routine procedures (eg urine tests); wasting paper, ink and postage; and breaking patient confidentiality by looking over the shoulders of doctors and pharmacists.

And now I am off to look up the recipe for boeuf bourguigon.

1 comment:

  1. You have every right to "complain". There seem to be no incentives whatsoever to do the right thing, not for physicians, nor for patients.

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