Tuesday, June 29, 2010

The Greater Fool

Any suggestions about what you would do in this next situation? I'm interviewing my next patient for outpatient surgery.  While discussing her previous surgical history, she says that she had a similar procedure done last year and her insurance wouldn't pay for the anesthesia.  So my billing office had been sending her letters requesting reimbursement for the anesthesia provided.  The patient says we had coded the case erroneously and we should have upcoded the case to a more complex procedure so the insurance company would reimburse for anesthesia services.  She claimed she had been going back and forth with the office about why she refused to pay.

I explained to her that the procedure today is similar to that prior one.  The anesthesia coding would probably be the same.  It would be a crime for us to change the procedure code just so we would get reimbursed from insurance.  She said if that was the case she is highly unlikely to pay for anesthesia services if the insurance company won't pay.

So now what do you think?  Should I have cancelled the case and risk the ire and wrath of the surgeon and the surgery center because of MONEY? Or would it be reasonable to proceed? Who is the greater fool, the patient for not paying money for services rendered, or me for proceeding with a case knowing that there is a high risk I won't get paid for it?  Should we all just become employees of the federal government and ObamaCare and forget about all this billing thing?


  1. Tough situation. As a resident it's hard for me to say what I'd do, since I don't really know or care about billing at this time. That being said, I would hate knowing I'm about to do something that the patient has already not paid for in the past and likely won't again. In an outpatient surgery center, from my little experience, the surgeons are the bigger concern because they're generating most of the revenue. Therefore, to cancel based on your perceived concern about not getting paid would look terribly bad and might land you on a "Won't work" list. Plus, there are collections companies that can take up the fight for the bills without you having to look mean in front of everyone.

  2. Recently started to read your blog and by the looks of this concierge medicine looks like a great ball park.....