12/18/2015    Robert Kornfeld, DPM

Rejection of Claims and Refund Demands

PM News (12/16/15) had two posts relative to the
battle podiatrists face with insurance companies
and Medicare, not to mention the ICD-10 debacle.

For years, I have been reading these posts where
DPMs look for ways to get paid or fight back
against insurance company rejections. All I can
ask is why? After all the years of commitment to
education and the obtaining of medical and
surgical expertise, how (and why) would any
doctor allow themselves to be at the mercy of
insurance companies in order to make a living?
Why should any of you have anxiety while coding
your claims? Why should any of you fear audits
and demands for return of monies paid? Why would
you allow yourselves to be demeaned and belittled
on a daily basis by companies whose sole agenda
is not to pay you?

I learned something a long time ago. Insurance
companies have no power over doctors who do not
participate. As a matter of fact, the more
doctors do not participate, the more you devalue
their product. When insurance companies do not
have the willing participation of doctors who
wish to be controlled, not paid properly or in a
timely way and cooperate with all of the absurd
guidelines imposed on them, guess what? They will
have to come up with a better idea to get you to
participate with them (if that is your choice).
My patients pay at the time of the visit.

I do not participate with insurance companies and
I do not accept assignment on out of network
claims. That way, if the insurance company
doesn't pay, the issue is between the patient and
the insurance company. And that is where it
should be. When patients get pissed off, they
complain louder and have more impact (afterall,
they are the ones paying the salaries to the
insurance company) and insurance companies
respond quicker than if a doctor calls to
complain.

My opinion is as long as you convince yourselves
that you have to participate (cooperate) with
insurance companies, that is how long you will be
miserable. That is how long you will have to see
an inordinate amount of patients everyday to make
ends meet. That is how long you will feel
victimized. That is how long you will miss the
beauty of being a fee for service doctor. Think
you can't do it? Think again. And again. And
again.

Robert Kornfeld, DPM, Port Washington, NY

Port Washington, NY

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