Oct 08 2007
The de coding agents
Mammogram is one of the few things that health insurer like Aetna provides free annually. I switched to a different plan this year, and got billed for the service back in March. I ignored the first few. It’s waste of my time to have to wait on the phone for a while for them to sort it out. They ought to know how to get thing right, and get paid. But by the 4th bill, I felt the problem isn’t going away - they do deserve to get paid, and perhaps the plan I switched to doesn’t provide the free preventive care any more. So I called. The insurer assured me that yes, my plan comes with free annual check ups that includes mammogram. But the code the radiology group used isn’t for annual check up, hence the claim was denied. I then called the group, the billing girl first said, “no, it wasn’t an annual check up ..” then corrected herself after few moments. And muttered out loud, “we tried many codes .. there is so many codes, we tried them all.” I don’t know what to say. And wondering why there is a coding process to begin with? I do see ads for vocational schools that offer career in medicine, such as transcribing, billing and coding (???) Wouldn’t be it easier that at the time of consultation, the dr types up the problem/note and enter the code right there, that can be transferred to the insurer without any more labor/mistake incurred?
In 1999, Michael Lewis published The New New Thing about Clark’s two successful IPOs, Silicon Graphics and Netscape (one venture capitalist committed suicide after begging for the Netscape but didn’t get it). At the end of the book, he mentioned that Clark’s next pet project was Healtheon, to streamline the cumbersome US healthcare system. I found the idea amusing if not absurd that American health care system needs an entrepreneur to do something about it. Why just streamlining it, how about fixing it altogether? Health care runs as a business, for there is a large contingent of people without any medical training are profiting from it. Ridiculously high cost of malpractice insurance, plus a large staff just trying to get reimbursed - someone else will determine how much and when you’ll get paid for your hard work. If Bill Gates came around, hiring lobbyists, why don’t the doctors? Or maybe theirs aren’t as powerful as the MBAs or HMOs? Sheshi, I think being a doctor nowadays isn’t much fun, at least isn’t about his or her fine craft in healing sick and ill, rather than out wit the MBAs who hold their wallet. Hillary tried to fix it once she took residence at the White House, and is trying to do it again as the main occupant of the White House. Why the doctors’ rates are being dictate by the HMOs or the like? If they’re smart enough to get into medical school, graduate from it, survive the inhumane residency/internship, why can’t they manage their own wallet? Harvard’s MD/MBA program seems bit late to the game? But at least it offers drs a chance to learn how to manage their own financial affairs. The first step should be to eliminate those useless middle men like coding agents. How to deal with uninsured is another weighty topic that beyond my comprehension.