Health Insurance: The Good, the Bad and the Indifferent

May 28, 2023 by Andrew Spracklin

I’m going to go on a little bit of an explanation or rant as some would call it based on a few phone calls that we have gotten recently. It never fails that about 10 days after we bill we begin to get phone calls explaining that they don’t owe us money, their insurance should have paid for the service. Don’t get me wrong, I want your bill to be as low as possible but we are obligated to bill what we do, run a business that actually pays its bills and to follow the contract that is laid out by the insurance company that we agreed too.

We obviously have preferences when it come to certain insurances, as some process quicker and are more efficient but we are not naïve enough to say that we won’t take certain insurances, at this point. Most individuals don’t get to pick what insurance their employer picks for them and if you choose off the Marketplace, cost and coverage are a huge factor.

I read an article a couple days ago indicating that the University of Nebraska is moving back to Blue Cross/Blue Shield.  This is great news for most providers as it is one of the few companies that is efficient and easy to work with.  Not that other companies are difficult as most things are done electronically, BCBS just seems to process quickly and without much headache.

Certain insurances cover certain services while other don’t cover other procedures, bundled services are a thing.  When we bill one CPT code (what we do) some other CPT codes may not be covered as the insurance company considers them to be bundled and don’t reimburse for more than one thing on one particular visit.  If this seems confusing to you, it is even as the doctor and staff that try to keep up with it on a daily basis.

I’m going to give an example: we are in-network with Medicare, when a new Medicare patient comes in we know that the initial exam and therapies are not covered under the plan, we explain this to people and have people sign an ABN indicating that you as the patient understand that certain services are “non-covered services.” We don’t do this because we like to, we do it because we have to. The rules are the rules with certain companies and when we sign up with them, we agree to follow the rules.

I’m not all that interested in receiving phone calls from patients telling me that I will be getting a phone call from their insurance agent and that they are disappointed in me for the bill that they received. The staff hates taking the phone calls and honestly, there is not a lot to do about it. We do initial exams on EVERY new patient, it would be irresponsible not to, we need to cover our basis as well.

If you are unhappy with your insurance coverage, take it up with Congress if you have Medicare, the State Legislature if you have Medicaid, your HR department for your employer based care or pick a different plan on the Marketplace.  We aren’t sending out bills due to spite and if you are refusing to pay the bill and threaten the office because of a bill, I will gladly give you a referral to another office that will bill you the exact same way if not worse.

This is not intended to be a mean post, but it gets very frustrating explaining insurance to people that have no idea what they actually have and then get mad at us when we are just doing our job. We sign contracts with companies not because it’s fun but because patients want to go to providers that are in-network with their coverage and possibly have things paid for based on how the plan is written.


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