Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Wednesday, July 07, 2010
Medicare Oh Medicare
I've written before about the difficulties I'm having with Medicare because I simply wanted to change my address. Medicare has 221 downloadable forms, none of which are change-of-address forms. In order to do this, I needed to fill out a 27-page enrollment form. I did, but was rejected because I didn't also fill out a 5-page form giving Medicare access to deposit funds in my bank account. Oh, but I'm a non-participating provider--- Medicare pays the patient, not me. And, I work in a clinic where they bill Medicare for my work under my name, and I certainly don't want money that belongs to the clinic going to my bank account. There's no upside to them having this information, and much potential for hassles. I filed an appeal, and it was denied. This has been going on for months. I've stopped being aggravated, and I was pleased when one of my patients mentioned she'd gotten a reimbursement check, so who knows how long I will exist, and I may surrender and send them my bank information and hope for the best.
You can read about my prior rantings Here and Here.
So the day of my latest rejection by Medicare, Meg was kind enough to send a link to an article about a Medical Society President (a dermatologist) who opted out of Medicare. The Business Review writes:
Dr. Leah McCormack, who has a dermatology practice in Forest Hills, said in an open letter dated June 30 that “I can no longer bear the shackles of government and insurance company rules, the burdens of their regulations and the fear of their retributions for the paltry reward of their monetary compensation for my services.”
The article goes on:
“I have been in the solo private practice of dermatology for 25 years,” she wrote. “I have tried to practice with the total focus on my patients, but this has become impossible. My staff and I spend an exorbitant amount of time dealing with claim denials, insurance managers, pre-authorization managers and pharmacy benefit managers. There is so much health system managing that there is little time for health care.”
Thanks for the heads up, Buggy!
Posted by Dinah on Wednesday, July 07, 2010
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I've been dealing with my own hassle with Medicaid, in trying to get my physical therapy place accommodated.
Stupid stuff like, even though we photocopied and handed them our primary ins. info when we turned in the paperwork to Medicaid, Medicaid doesn't show any insurance, so it doesn't show as secondary, so the physical therapy place can't bill it right, so I had to redo the info, and now we have to wait for it to work its way through the system and a new card to be sent to me, or for a call back to me saying whether or not I need to wait for the new card or just give a week for the info to make its way into the online database . . . it's a good thing the physical therapy place are nice and patient people, it's one of the reasons I chose to go back there after the second surgery, they are great to work with.
I also am going to have a hassle with Medicaid about getting my psych meds approved, they don't even have a category for them on the preferred drugs list for my state, probably because they'd like ALL drugs in those categoriy(ies) to be vetted, ugh. So I'm going to have to ask my non-Medicaid taking psychiatrist to deal with the form, for each medication, for getting them approved, since our regular health insurance runs out the end of this month. The doctor needs to fill out the form, as it needs to become a part of their records, and there is details that only they can put on it. So I hope that she has dealt with it before; the whole preferred drug system has only been around since May '09. UGH!
But I won't be able to afford my meds otherwise; not sure how I'll afford to see her after this month, but I might have an option up my sleeve.
i DO know I will be coming off the detested trial of Geodon; I had some unusual bleeding symptoms, different ones, two days in a row that necessitated a weekend call to her cell phone as I was a bit freaked out and unusually freaked out that I was going to die (but the Geodon has been making me freak out more than I usually would, too). I HATE THIS MED. Nothing like feeling on edge all the time. Anyway, not looking forward to the Medicaid hassle with the meds.
Pre-Auths required in Dermatology? I thought it was just we lowly psych professionals who had to deal with pre-auths.
And yes, I've got my own Medicare hassle - been working on it 6 months. One rep says my request is do-able but call a different number. Call that number and they say it is NOT doable and to call back to the original. Classic right-hand, left-hand stuff.
I so understand the Medicare change of address hassle as I've completed those 27 pages multiple times. And, the Medicare conundrum continues with the opt out process. I am a provider so if I opt out my clients, current and future, are unable to receive reimbursement for three years!
The doctors want their "freedom" from insurance companies, but that freedom comes directly out of client pockets. It puts clients in the situation I have been in for a number of years: a gyn and endocrinologist neither of whom take insurance. So I pay $850 a month for insurance then pay $350-$750 depending on the visit, out of my pocket to see one of these 2 doctors and none of it applies to my deductible of $2,000 nor is it reimbursed. Finally out of financial necessity I switched to in-plan doctors in each category despite wanting to stay with the others. I just can't afford it any more. A doctor had better have deep pocketed patients before turning a back on insurance. Whenever my former endocrinologist would say, let's see if your thyroid feels OK or if you might need surgery, I would think "Well the surgery won't be with you if I need it!" It irked me as was a "last straw" as it were when my gyn charged me $300 more than normal because she spent 10 + minutes haranguing me because my mammogram center uses film X-ray instead of digital. I have been going for mammogram at the same place for 25 years and know as a photographer that digital is not better, so this "discussion" with her pushing me to go to "her choice of mammogram center" versus my long time choice cost me $300. Then the endo spent an equally long time on my case because I am overweight. Well I am, and I like to not be, but HE is fat also and does nothing about it. I have dieted for 40 years and am more than 100 pounds less than my sister, so feel some sense of success. Well, that discussion also cost me up the ying yang and I have had it.
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