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March 04, 2010

Physicians Also Need Reform

169186_stethoscope_5 Like many, I have followed the on-going health care debates closely. I fall on the side of universal coverage for all. I cringe, every December, when my husband brings home the specifics of his company's health care coverage for the next year. Small families are discriminated against. As a family of three, we pay more for coverage than say a single parent with five children.

This year we had the option of paying the same amount for less coverage or maintaining 2009 coverage for a mere 30% increase. We opted for the same cost with less coverage and higher deductibles. We are praying no emergencies require us to meet that higher deductible.

But as much as we complain about the insurance industry, sometimes inefficiency occurs as a result of the physician. There have been numerous times in the past, frustration level mounting, as I spent endless hours trying to sort through a billing or payment error. When my daughter was born, the pediatrician billed the first visit before the required month that it took to place an infant in the health insurance system. For two years, the doctor's billing department complained that no coverage existed for the period in question. The insurance refused to pay because of the date the bill was submitted was before our daughter was in the system. When the issue was finally resolved, we were under a different insurance company and my husband's employer ultimately paid for the outstanding doctor's visits.

It's as if you are caught in some sort of endless circle between the doctor and the insurance company. Recently, I tried to verify coverage for a new mouth splint for my TMJ. The insurance company informed me on three separate occasions that the splint was covered. But the oral surgeon insisted on $700 in advance, stating that the insurance company would not absolutely verify coverage of the appliance until after the bill was submitted.

I grudgingly paid the money. What choice did I have? This was the only oral surgeon, within 20 miles of my home, on my insurance plan. And we live in a huge metropolitan area. The splint was covered and I received a full refund. However, what if a person didn't have the discretionary income for the splint? A splint that is covered under their policy! All because the patient is caught up in some kind of word game between the doctor and the insurance company.

Despite all my complaints about insurance companies, I hate to admit that my current company did something right! Our insurance company mails out a monthly statement of all activity on our medical and prescription policy. In reviewing the last two month's statements, I have found three incidents, where we paid more upfront for medical service than was required. Between the ophthalmologist, a primary physician, and the hospital where I have mammograms, we overpaid $168 dollars. When I called, they all confirmed the overpayment but none had initiated a refund.

All three offices promised to issue refunds. It has been over a month since my calls. To date, I have received only one of the three refunds. I am owed $20 from my primary physician. His office suggested the credit remain until my next visit. But I requested a refund. It's not much money, but it's the principle. Do you think a doctor would choose to wait until the next visit to seek payment for an outstanding amount of $20? Hell no! They often initiate billing before insurance is even filed!

So, as much as we talk about flaws with the health care system in this country, maybe physicians could use some reform also.

This is an original 50-something moms blog post. When she's not arguing with doctors, Debbie also blogs at Diaries of an Older Mom