The Medical Quack: Doctors seek cash when insurance doesn't pay

This was a comment made by a reader on site commenting on the original title listed above and after reading this, I wanted to bring it forward as a post so it didn't get buried.  The name used to post "The Giving Tree" says it all.    The sad thing is that this practice is probably not alone and has company all over the country... but the level of dedication to patients is more than apparent...and after all the battles for reimbursement, the well has sadly gone dry....with bankruptcy to follow..not a word of anger here at all, just some very disappointing facts and state of affairs...BD  

I manage a solo family practice in Dublin, OH and we are days away from shutting our doors. The doctor filed for personal bankruptcy as we struggle to plow through the complex healthcare reimbursement matrix. Our AR is $174,000, about $115,000 after contractual discounts. Our reimbursement projection is 66% because of our high number of Workers’ Compensation, which pays 80-89%. The majority of these claims, generated since October 2007, are still outstanding.
We're lucky to see 20k of the 40k-50k a month we're owed, after contractual reduction. (Expenses total 25-30k/month, 7k+/month for rent alone.) It's not just lack of reimbursement, but improper reimbursement. Insurance companies expect us to pay for our patients' healthcare. For example the Meningitis vaccine costs $85 from the manufacturer; $115 from other suppliers, NOT including our cost for administration, as the Dr. and I are currently the only employees working for free. Tricare is our highest payer for the vaccine so far at $46, or 40-54% of our cost.

We don't have time to address appeals on all of our improperly adjudicated claims; buried by constantly changing rules and current claim tracking. Ironically, we receive letters stating the check is in the mail. We try to pay our bills with these letters, but we're still forced to pay 10-30% interest when we're late; offset by the $0.01-$0.31 paid in interest by insurance companies for claims paid late.
The practice has ninety days to 12 months, depending on the company, to force insurers to accept claims or we don’t get paid. Insurance companies have two years, according to our provider reps, to take back reimbursement of previous claims from money owed on current claims. I’ve even had to fight for money taken back that was never received.
“Take-backs”, an insurance company term, are a result of insurers giving patients credit, paying the claim or not, then taking back the alleged reimbursement after two years when an audit proves the patient or their employer allegedly never paid for their benefits. Thus, we're not the creditor but we’re forced to be the collector. The insurance company mantra "eligibility is not a guarantee of benefits" means, see your doctor and if we refuse payment or take benefits away after the fact, it's their fault.
This month we're forced to cease scheduling government healthcare recipients; except Tricare, and anyone who can't pay upfront, pending reimbursement. Tricare, United Healthcare, and Aetna help with real-time, online adjudication and direct deposit, but it may be too little too late. Like Shel Silverstein's The Giving Tree, we have nothing left to give.

The Medical Quack: Doctors seek cash when insurance doesn't pay