04/12/2018    William J. Lipkin, DPM

United Healthcare Reimbursements in NJ

While I do appreciate the replies, though sparse
as they were, I believe that "knee-jerk" reactions
of just dropping out of ALL poorly paying
insurance plans must be given great consideration
(otherwise no doctors or hospitals would accept
any insurance at all). Data collection would be
helpful to present to a local or our national
podiatric society, though, I am not certain of the
clout they would be able to muster in order to
achieve a fair and acceptable reimbursement for
their constituents.

The purpose of the post was certainly more in line
with trying to find out if any of my colleagues
have had success in being able to reach a provider
representative at this particular insurance
company so that meaningful dialogue about fees and
reimbursements could be initiated. I personally do
not have a lack of self-worth as one poster
suggested as I have been in my own successful
practice for nearly 20 years, however, there seems
to be more interest and posts about whether or not
the folks at Costco can make better or less
expensive orthotics than a DPM can. However, this
is not the purpose of my reply.

I do believe it is of utmost importance for every
physician (DPM,MD/DO, etc.) in private practice
who is not just working on straight salary to
review their EOBS routinely and not just let the
billing company or office staff "handle all of
this". Based on the lack of replies, I wonder how
many other podiatrists that are in network with
this carrier even noticed the drops in
reimbursement.

Fortunately, there are plenty of services that can
be provided to patients that are non-covered and
the patient may be charged a fair, reasonable fee
for the service to help offset this loss of the
bottom line. It is correct that I don't have to do
the P & A procedure for $99, but that same patient
may need a new pair of orthotics, may desire laser
treatment for mild-moderate fungal nail disease,
may have chronic plantar fasciitis that requires a
PRP injection, etc.

So, I think it is best to think with our heads and
not with our hearts concerning dropping completely
out of certain networks because you never know
what opportunities that new in-network patient may
bring into the practice. However, when my patients
start getting their orthotics through Costco, I
hope they will let me know so I can give them my
order for a pallet of paper towels or some snacks
for my office....would save me a trip.

William J. Lipkin, DPM, Hoboken, NJ

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