I thought that after finishing my surgical residency there was a magical place I could call where someone would take care of all the ‘money stuff’ so I could do my ‘doctor stuff’. All that hard work and school was about to pay off – I get to help patients all day and then go home to to spend time with my family every night….
Hopefully that got a few laughs from the healthcare crowd. For everyone else, especially patients, physicians are as frustrated and unpleased with the financial side of medicine as you are (if not more). But until the system finds an easier, better way to finance patient care, complaining does no one any good.
What many people do not know is that any health insurance plan is in reality a relationship between the insurance company and the patient. Contractually, it it the patient’s responsibility to reimburse the physician. But like most businesses, customer service in a highly competitive market becomes a high priority and standard over time. And it should. Not because I love capitalism and competition that both drive better quality in this country, but because our heads are in this part of the business all day.
The short version is that every private practice physician learns the billing process and everything about healthcare insurance quickly or the light bill does not get paid nor does food make it into their refrigerators. So making sure that your patients are well informed about their clinic visit, labs, surgery, or follow up care is a top priority. This is a win-win-win for all since both patients and physicians really want to get right down to treating the problem(s). The good news is that many insurance plans are leveraging IT to make this easier for the staff to have financial answers for patients before they come to the clinic. The not so good news is that the plans have an infinite variety of payment paradigms as well as many treatment and medical devices (DME) requiring authorization by phone. Sometimes my staff can be on the phone for over 45 minutes for one patient’s custom orthotics authorization or faxing short term disability requests for surgery week after week.
Just recently we have had a complaint about pricing, EOBs, and one patients ‘sticker shock’ for both clinic treatments and surgical procedure / surgery center quotes. It’s not uncommon and we understand that these complaints come with the territory, but in reality we are all following the insurance company’s contract agreements.
Unknown to some patients is that physicians have to follow a rule where we cannot change our charges for office visits or treatments (CPT codes). And, each insurance company has individual contracts with each physician paying them different amounts for each CPT code. Hence, the customary EOB (Estimation of benefits) patients receive showing the physician’s charges, the insurance company payment, and ‘adjustment’ amount.
All that aside, I believe that it is still in the best interest for clinics to have better customer service and patient communication. Be ready for those who have never had care, patients who have never had any procedures performed or those who simply want to know why their costs are ‘so high’ and other items are ‘not covered’.
Meet Vickie LaCoste. She is our administrator and works both with the patients and the rest of our staff to make sure everything is clear for patients before, during and after their first visit. From Cosmetic-Corrective surgeries (Bunion / Bunionette corrections, Toe surgery, Permanent corn removal, Heel ‘bump’ removal) to Reconstructive/Trauma (Ankle Sprains / Fractures, Arthritis Treatment, Plantar Fasciitis / Heel Spur, and Dermatologic problems (Ingrown Toenail, Fungal Toenails), patient treatments are as important as the patient experience at Moore Foot and Ankle Specialists.
Stay Healthy and One Step Ahead!