Next Tuesday, my summer of leisure will end. I was hired in my field to do AR management for Neurosurgery. Makes me sound smart, huh? What I actually do for a living is call various insurance companies, ask when they intend to pay for services and enforce the physician's contractual relationship with your insurance plan.
I have to say, it's pretty damn thankless work. When an insurance company refuses to pay for service, they generally tell their customers that the doctor must have billed it wrong. Then the patient calls and yells at me, usually using the term "YOU PEOPLE", to school me on what we did wrong. Except 90% of the time, we aren't wrong. They had a service their insurance company doesn't cover and doesn't have the balls to take responsibility for not covering.
I can't change a code unless the medical record dictates it is appropriate and the physician tells me it's OK. I cannot change a tax ID number to one that is in network with your plan. I can't change a date of service to one that gets your service covered. These requests are all fraud, and I don't look cute in an orange jumpsuit.
What always gets me is that no one ever thinks to yell at their insurance company for taking their monthly premiums and then not giving them what they are paying for. The assumption is that since you pay the insurance company, their answer is worth more than my answer, which you are not paying for. Trust me folks, you doctor is much more interested in your well being than any insurance company. Your insurance company is a for profit industry. They make their money by NOT paying out your claims. So they take your money, hoping to never provide you with a service. Your physician provides you with a service and then requests payment.
And really, please, do not argue with me about how much your doctor charges for his or her service. you don't question your hairdresser or mechanic about how much they charge. Isn't your health worth more to you? I know mine is. If you feel you need to negotiate, do so with the doctor BEFORE you get a bill.
Sorry about the work rant post. Now the question is, am I sure I really want to go back to this?
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