A Day at the Doctor’s Office—Anything but Routine Apr 9, 2014

by Joseph M. Valenzano, Jr.

Today, April 9, 2014, I had occasion to visit my doctor for a consult on a medical problem I have been dealing with for several months. Now, I have known my physician for over 25 years and he has treated my entire family over that period and still treats my wife and me. At the start of my visit he asked my help in researching with him some insurance payments that came in for visits I had with him back in January and February of 2014. I was only too happy to help. The issue was that he had either misplaced the insurance checks that I had received and signed over to his practice or the insurance company, a well known insurance carrier of substantial size and impeccable reputation, perhaps had not yet sent payment.

As my physician is "out of network", the carrier's policy does not permit him to speak with them alone; the patient, me or my wife, needs to be present while any call about medical claims is made. So, we were trying to deal with two issues at the same time—helping my doctor resolve his problem and helping me get some information about a medical procedure I am considering having done in the coming weeks.

We began with a phone call to the claims office of the insurance carrier at 10:15 AM. Six phone calls later to six different people led us finally to the person who was able to research our very simple question: Were payments made for the visits in January and February and, if made, were the checks paid and cleared through my physician's bank? Our practice for years has been to sign over any check received from the carrier to my physician.

As it turned out, one reimbursement from January was not yet processed. There was no real explanation as to why, but the person took care of it immediately while we were on the phone. Two other claims were bundled together and one check was issued with an explanation of benefits appended to it. But for some reason it had not been cashed by my physician and still was outstanding. The person from the insurance carrier immediately recognized that this payment, while made by the carrier, was more than 60 days old and so she immediately reissued another check to me, which I will immediately sign over to my physician when I receive it. That was at 11:05 AM, 55 minutes after we made the phone call to the carrier from my physician's office.

Normally, my physician's administrative assistant would have handled this while he consulted with and treated me. But she was on vacation this week so he asked for my help. I am happy that things worked out but the thought of this continues to nag at me. Let's assume that I am only one of four or five patients of my physician. And let's assume for the moment that it does not take 55 minutes to resolve each case and that a more realistic time period might be a half-hour. If five people are involved, that would require two- and-one- half hours of unnecessary phone calls, paperwork and bookkeeping research...instead of delivering care which is the career my physician was trained for and has delivered with quality for many, many years.

Think about it. And then think about this: Does anyone really believe that with the implementation of the Affordable Care Act (a/k/a "Obamacare") what occurred today will improve? I don't. In fact, I think it is going to be much worse and the quality of healthcare delivery will suffer. It already has, and for all of us Baby Boomers, that thought is both depressing and ominous.

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