IOP supervised/run by internist?
Can non psychiatrists be the supervising physician overseeing IOP programs? Specifically not an internist with addiction medicine training, just 3 year IM residency and over seeing CD and/or mental health IOP. Could there be issues with insurance fraud or other problems? (Source: Student Doctor Network)
Source: Student Doctor Network - November 18, 2023 Category: Universities & Medical Training Authors: nexus73 Tags: Psychiatry Source Type: forums

Resident Continuity Clinic vs "Real World" Outpatient
A vast majority of my colleagues go into hospital medicine upon graduating. Even those thinking of doing outpatient end up taking hospitalist jobs. My program is very inpatient heavy and the only exposure we get to primary care is our continuity clinic where we commonly see low-functioning, uninsured, uneducated, chronically co-morbid, often drug addicted patients. We get a taste of insurance company denials, mountainous levels of paperwork, and an outdated EMR (eCW). Could this lack of... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 16, 2023 Category: Universities & Medical Training Authors: BillBill1219 Tags: Internal Medicine and IM Subspecialties Source Type: forums

RFA frequency
Straight Medicare insurance. I did a medial branch RFA for a patient one year ago at THREE levels (billing told me I could) that worked well, >50% pain relief for over a year. Later came to find out that we did not get reimbursed for the third level. Fast forward a year, I repeat the RFA but only at two levels given our prior denial. Patient reports unsatisfactory pain relief. I looked over the previous and current fluoro images and the needle placement is nearly identical. My question is... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 15, 2023 Category: Universities & Medical Training Authors: Greenbayslacker Tags: Pain Medicine Source Type: forums

Insurance credentialing hospital privilege
I want to go into private practice in Texas and I would like to get on insurance panel. I do not currently have hospital privilege and do not work at a hospital. My credentialing person says I need to either work at a hospital or get a letter from someone who does. Don't have that currently as options. Has anyone encountered it and is there any work around to it? (Source: Student Doctor Network)
Source: Student Doctor Network - November 15, 2023 Category: Universities & Medical Training Authors: nimat_do Tags: Psychiatry Source Type: forums

Regional variation in reimbursement
Working up in the Northeast. A frequent complaint I've heard about the area, particularly the state I am in, is that insurance reimbursement for all medical services (not just pain) is significantly lower here than in other adjacent states, or even other parts of the country. If this is true, is there any resource or way to determine which regions may offer the best rates for service, or is this just a matter of contacting insurance companies directly. While I have a job I can tolerate for... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 13, 2023 Category: Universities & Medical Training Authors: agolden1 Tags: Pain Medicine Source Type: forums

ProPublica Picks Protons
Big Insurance Met Its Match When It Turned Down a Top Trial Lawyer’s Request for Cancer Treatment Blue Cross and Blue Shield denied payment for the proton therapy Robert “Skeeter” Salim’s doctor ordered to fight his throat cancer. But he was no ordinary patient. He was a celebrated litigator. And he was ready to fight. www.propublica.org (Source: Student Doctor Network)
Source: Student Doctor Network - November 8, 2023 Category: Universities & Medical Training Authors: winstonfoot5 Tags: Radiation Oncology Source Type: forums

Advise: insurance fraud?
So I usually hang out on the premed forums, but I got this job offer working in a psychiatric private practice. I went in for training and noticed many red flags with the psychiatrist. He charges $250 for medication management and psychotherapy to insurance (100 out of pocket) but spends less than 5 minutes with each patient. Patient files are paper but the only thing in them are printer paper that has a few scribbles on it (nothing legible, not like his actual hand writing). So my question... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 8, 2023 Category: Universities & Medical Training Authors: kjs551 Tags: Psychiatry Source Type: forums

SDG job consideration-Predatory or the norm?
I’m looking into EM attending jobs in a new city and wanted to get feedback regarding an SDG job that I’ve come across. Medium cost of living city with a stable private democratic group that has had the hospital system contract for 30+ years. They have a stable contract with a specific health system staffing 3 of their hospitals in the metroplex. Partnership track: sweat equity buy-in for 2 years with a base salary of $220k for 1620 hours/year. W2 with subsidized health insurance, fully... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - November 5, 2023 Category: Universities & Medical Training Authors: rufio79 Tags: Emergency Medicine Source Type: forums

Modesto CA
Full time permanent job. Start $600k w2. Full benefits plus $40k 401k. Full family health insurance, etc. 6 weeks off. Flexible schedule. 2 in house calls per month. 1 weekend per month. 2 yrs partnership. No buy on. Partners $600-750k. Pls pm. (Source: Student Doctor Network)
Source: Student Doctor Network - November 5, 2023 Category: Universities & Medical Training Authors: tdub878 Tags: Anesthesiology Positions Source Type: forums

Indemnification clause: please help..
Indemnification clause: what are your thoughts on having this in a contract? My understanding is that it puts me at huge risk for liability and malpractice does not typically cover this. How would I get it removed? If they refuse, is it worth the risk signing? Also, any other ways to protect self if one is included in a signed contract? Ie other types of insurance (Source: Student Doctor Network)
Source: Student Doctor Network - November 1, 2023 Category: Universities & Medical Training Authors: Psych25 Tags: Psychiatry Source Type: forums

Malpractice insurance
I’m planning on leaving my employed position and going to a private practice. They don’t provide malpractice so I need to purchase my own. I feel pretty lost any advice? Ballpark prices I’ll be looking at? (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2023 Category: Universities & Medical Training Authors: Attending1985 Tags: Psychiatry Source Type: forums

Hospital Employed, Making Sense of Financials
I’m hospital employed doc struggling to understand my net operating income. I have a good sense of revenue (both top line and after-insurance amount paid). I cannot discern my costs. My hospital can only produce for me a list of “charges.” Charges include straightforward things like lidocaine, dressings, etc. It also includes wildly inflated charges like SCS leads, up-charged at a pre-negotiated supply rate (2x-10x, depending on cost). It also charges my department for my time at a... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2023 Category: Universities & Medical Training Authors: Czech777 Tags: Pain Medicine Source Type: forums

Patient keeps asking about a letter from me for gender affirming surgery
County clinic M2F patient who wants to have gender affirming surgery wants a letter from me that she is stable to have surgery. She said that the insurance company is asking for a letter from me stating she is mentally sound and competent to under go the procedure. I thought psychiatrists who usually work with surgeons to do these pre-op evaluations. Is this something psychiatrists working in a county mental health department usually do? (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2023 Category: Universities & Medical Training Authors: the5thelement Tags: Psychiatry Source Type: forums

Spine MRI without/with contrast denials
I recently moved out East and have been ordering post-op spine MRIs without and with contrast (as I always have). I am getting pushback from insurance companies and radiologists about this - they want a plain MRI or a different Dx code. First of all, am I missing something regarding ordering post-op spine MRIs with contrast? I though we wanted to discern scar tissue from HNP. Did something change and I don't know about it? Secondly, if it is still recommended to order with contrast... Read more (Source: Student Doctor Network)
Source: Student Doctor Network - October 19, 2023 Category: Universities & Medical Training Authors: knoxdoc Tags: Pain Medicine Source Type: forums

SCS psych clearance delays
I've identified patients I'm considering for neuromodulation but have been getting held up by the psych clearance portion - long wait times, insurance non-coverage and patients having to pay out of pocket (even the telehealth options). I'm exploring the idea of hiring a liscensed psychologist as a contractor for the group to expedite the process on a per-eval basis. Anyone have any experience with this and Is a practice allowed cover the cost of the eval? (Source: Student Doctor Network)
Source: Student Doctor Network - October 17, 2023 Category: Universities & Medical Training Authors: ChiSox Tags: Pain Medicine Source Type: forums