Company takes money from docs AND patients
Just lovely
Health Insurers’ Lucrative, Little-Known Alliance: 5 Takeaways
A private-equity-backed firm has helped drive down payments to medical providers, drive up patients’ bills and earn billions for insurers.
www.nytimes.com (Source: Student Doctor Network)
Source: Student Doctor Network - April 7, 2024 Category: Universities & Medical Training Authors: bedrock Tags: Pain Medicine Source Type: forums
Consequences of "overbilling"
I see a lot of variety in critical care billing practices. For example, I see some docs are routinely billing critical care time for anyone in the ICU even if stable and going to floor or home that day or totally hemodynamically stable just there for q1h glucose checks for DKA with insulin gtt.
Is it recommended to just err on the side of billing for critical care and if it doesn't meet criteria the coders or insurance company will just change it to non-critical care? If lots of physicians...
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Source: Student Doctor Network - March 5, 2024 Category: Universities & Medical Training Authors: Student3322 Tags: Critical Care Source Type: forums
Ozempic Bull**** (again)
Mandelin Rain said:
Especially with the UA companies being chronically "understaffed" (sarcastic air quotes) and requiring 14 days for review and then 7 days to schedule a peer to peer.
This should be illegal. It's a delay tactic for cancer care. Obviously that sweet insurer lobby money will keep the grift going.
Click to expand...
Our system can’t even do anything about the ozempic situation which threatens to make us insolvent. You think policymakers are going to fix prior auth for radiation? Our form of medicine, is...
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Source: Student Doctor Network - February 7, 2024 Category: Universities & Medical Training Authors: MidwestRadOnc Tags: Radiation Oncology Source Type: forums
Best and worst insurance companies for pain physicians
As a pain doc, what are your 3 favorite and 3 least favorite payors? (Cover pretty much everything and/or reimburse well) (Source: Student Doctor Network)
Source: Student Doctor Network - February 4, 2024 Category: Universities & Medical Training Authors: lmsanscafe Tags: Pain Medicine Source Type: forums
Suggestions on referral sources for new private practice
I am curious what all of you have found to be successful for patient recruitment. I am paneled on several insurance companies but not the biggest in my state. What I have done thus far:
-Zocdoc- complete trash for out of network referrals, perhaps 1/5 actually turned into a patient, I restricted it to only in network referrals.
-psychology today- steady but slow, getting only 3-4 new patients a month
-networking with local PCP- so far nothing, they have been very receptive, but I just...
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Source: Student Doctor Network - February 1, 2024 Category: Universities & Medical Training Authors: budda10000 Tags: Psychiatry Source Type: forums
Using AI in Pain Management...
If I were an insurance company and found out that a pain doctor used a virtual AI ambient scribe to create clinical documentation that incorporated all the medical necessity criteria from the health plan's medical policies for interventional pain procedures into the note, and then prompted the clinician to ask specific questions at the end of the encounter if said criteria were not fulfilled, I'd be pissed... (Source: Student Doctor Network)
Source: Student Doctor Network - January 3, 2024 Category: Universities & Medical Training Authors: drusso Tags: Pain Medicine Source Type: forums
Is it normal for insurance companies to request a treatment plan for a member you provide services to?
I got a voice message from a BCBS RN case manager requesting a treatment plan from me for a member of theirs I see. Is this typical? What should I expect? What do you do? (Source: Student Doctor Network)
Source: Student Doctor Network - December 15, 2023 Category: Universities & Medical Training Authors: texanpsychdoc Tags: Psychology [Psy.D. / Ph.D.] Source Type: forums
For private practitioners, who are you networking with for referral sources?
I was curious to see what all referral sources private practitioners are getting involved with.
Right now, mine are insurance companies a psychiatrist and a psychologist who routinely refer to me, and I also get the random referrals from unknown physicians, psychologists, and other therapists.
I am looking to find a good solid referral source to get steady patients, so any thoughts and examples would be greatly appreciated. (Source: Student Doctor Network)
Source: Student Doctor Network - December 11, 2023 Category: Universities & Medical Training Authors: texanpsychdoc Tags: Psychology [Psy.D. / Ph.D.] 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...
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Source: Student Doctor Network - November 16, 2023 Category: Universities & Medical Training Authors: BillBill1219 Tags: Internal Medicine and IM Subspecialties 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...
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Source: Student Doctor Network - November 13, 2023 Category: Universities & Medical Training Authors: agolden1 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...
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Source: Student Doctor Network - October 19, 2023 Category: Universities & Medical Training Authors: knoxdoc Tags: Pain Medicine Source Type: forums
Payment Processing Fees
I just listened to this podcast on white coat investor and found out that there are companies that "facilitate" electronic payments to physicians but unlike Visa or Mastercard that take 1-3% or so from merchants, these guys are taking up to 16% before the money even gets to your office.
I also found out that the insurers use ghost codes to decrease "payments" to people who don't provide sedation (such as family doctors) which gives them justification to decrease payments to...
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Source: Student Doctor Network - October 13, 2023 Category: Universities & Medical Training Authors: GassYous Tags: Anesthesiology Source Type: forums
Just started a private practice....now what?
So I'm a recent grad, have a couple jobs which more than pay the bills while I get my practice up and running. I am currently listed on psychology today. I am paneling with a couple insurers and the rates I got back from one of them today (a major payor on the west coast) was beyond low. Like $40ish for 90833, $80ish for 99214. My office is in a nice area of Los Angeles, so very HCOL.
I've so far gotten nothing via psychology today. Not even an email. I'm afraid if the other two insurers...
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Source: Student Doctor Network - October 4, 2023 Category: Universities & Medical Training Authors: Psychresy Tags: Psychiatry Source Type: forums
Threats to audit from insurance companies
Got a letter recently from the only insurance company I panel with that I'm billing too many 99214's and 90833's. Somewhere in the 80% range. Everyone at our practice got this letter. My follow ups are all 30 minutes, and the vast majority of my patients have at least two chronic conditions with med management (my understanding is this is enough for 99214 with MDM) and I document supportive, CBT and family work. It's usually 10 minutes for meds and 20 minutes for psychotherapy. Not everyone...
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Source: Student Doctor Network - October 1, 2023 Category: Universities & Medical Training Authors: StayOnTop Tags: Psychiatry Source Type: forums
