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03/19/2014 Simon Young, DPM
178K Out-of-Network Payment to NY Podiatrist Spurs Investigation
It seems outrageous that foot surgeons out-of- network charges are paid with such little oversight. As usual, podiatrists are not the only practitioners involved in this practice, but in this case a podiatrist took it to a different level of greed.
How is this different from what insurance companies do to the in-network doctors who are part of the solution to our healthcare crisis. The multiple of millions of dollars needlessly denied for proper services billed.
United healthcare/oxford screws me regularly and twice on Sundays. I love their one penny checks. I love how they try every trick in their bag of tricks to deny my services. I love how they won't help you with billing issues you have. There are thousands of examples.
What about lies, misrepresentations from all these insurance companies such as BC/BS, UHC, etc to deny coverage after preauthorization is garnered.
The State "for the" insurance department of New York does nothing.
NY State Podiatric Medical Assoc wants forms and is generally ignorant even when presented with obvious "no-brainer" evidence and cant understand why members don't inform NYSPMA. Members of the insurance committee can't understand my handwriting, but won't review the denial codes.
Many practitioners are hemorrhaging money and I don't see an emphasis to rectify these injustices. Ankle privileges in NY is more important than helping members earn a basic living and of course our outrageously hi dues.
No doubt Dr. Levine's greedy actions will impact every in-network provider while she lived high on the hog on Park Ave. Toting her skills to the profession through pricey seminars and selling her line of "cosmetics" for feet, while perpetuating this outrageous practice. Such unspeakable narcissism and professional moral and possibly ethical fraud. I am surprised it wasn't realized sooner.
When will the doctors attack the legislators and state "for insurance" departments to examine these "insurance middle men"with the same veracity, scrutiny, and intensity United Healthcare ?will impose on Dr. Levine. Rightfully so on both sides of the aisle.
Simon Young, DPM, NY, NY Simonyoung@juno.com
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03/21/2014 Brian Kashan, DPM
178K Out-of-Network Payment to NY Podiatrist Spurs Investigation
While I rarely get surprised by anything these days, I have to admit that this unfortunate story left me speechless. This exemplifies the hypocrisy of our health care system, and the selfishness by some trying to stuff their pockets regardless of the repercussions. I am not only referring to some provider’s greed, but the insurance carrier’s greed that may sometimes cause the provider to rationalize the over-the-top behavior as some sort of revenge. The provider-insurance carrier relationship has frequently been adversarial. Ridiculously low reimbursements, policy changes, and restrictions have sometimes been met with increased utilization, and “creative” billing to offset those changes. This is met with more policy changes and then more creative billing, so on and so forth. However, submitting a bill for several hundred thousand dollars to an insurance company, in my opinion, is an insult to our profession and the epitome of selfishness. Years ago, I recall the car makers in Detroit eliminated podiatry from most of their plans. The basis of this was the usual number of claims and procedures being performed by podiatrists. The result was extreme hardship for many of our colleagues who practiced in this area. When people believe that their actions do not affect others, and that they will fly under the radar because they are only one small individual in an ocean of fish, outlandish examples like this flourish.
While there are many failures in this particular example of $178,000 for several small surgical procedures, the results of this will have widespread implications. Once again podiatry will be looked upon as a greedy profession, creating problems within the healthcare system that will result in limitations and restrictions. Believe it or not, what each of us does affects all of us. We do not practice in a bubble. My first reaction when I read this story was how many of us struggle to abide by the policy and rules in a shrinking reimbursement pool, have to bill by the number of toenails trimmed, the number of corns cut, provide medical documentation, reports, and try and abide by government mandates and requirements on an increasing basis. If I provide services to a diabetic patient, one day before the 61-day requirement for covered services, my claim gets rejected. If I forget to put a modifier on a claim, my claim gets rejected. If I don't submit a claim in six months, my claim gets rejected. If the patient changes their insurance and doesn't inform us correctly, through no fault of our own, our services are rejected.
The insurance companies can go back and audit our records and retract payments that they may unilaterally feel are incorrect. These examples can go on and on. Then I see that an insurance company paying $178,000 for relatively minor procedures, and I ask myself what is going on here. There is such scrutiny on one hand, and not enough scrutiny on the other. All I can say is that we each have to look ourselves in the mirror every morning. Do not develop the attitude that you are doing something wrong because you are doing something right. The excuse that everyone else is doing it is just not correct. Everyone else isn't doing it. Most of us are going above and beyond in our efforts to provide care and comply with so many changes. Healthcare is changing and we must change with it. However, that does not give us the right, nor justification to selfishly engage in activities that are harmful to everyone involved and have large repercussions for so many.
While a $178,000 deposit in your bank is quite impressive, the cost to all of us are immeasurable. In this case, I would hope that common sense prevails, appropriate reimbursement made for the services provided, and that proper action be taken by all parties to prevent this from happening again. Brian Kashan, DPM, Baltimore, MD, drbkas@att.net
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