Insurance

A few weeks ago, there was a challenge on the SOAPM list to come up with the Top 10 Most Egregious Insurance Company Behaviors.  Dr. Budd Shenkin compiled and edited the list which, in the draft you see below, I find quite impressive. 

Of course, I'd love to hear of any additions you might have - no need to limit us to 10.  I have a few that I might use as amendments.  Enjoy.

For the record, I'm not in favor of a single-payer system.  But I'm also not a fan of much of the rhetoric that I hear against the concept.

In particular, I have always wondered why those advocating for the strength of choice aren't presently railing at the lack of payer choice for both physicians in patients in so many places.  I remember my first time confronting this when I was in Rochester talking to some practices about insurance negotiation and they asked, "What if the plan represents 75% of my business?"

It started when Susanne Madden sent me this "nice" message from Horizon to help me warn our clients about games Horizon continues to play.  Bottom line: they expect to stop paying for -25 or -59 modified codes starting May 10, 2010.

I had grand plans to keep track of all the different payers and publicize/shame many of them, but by the time the data came in...it was too late.

Still, how have PCC clients fared with the new H1N1 administration code? 

Better than I would have guessed.

OK, I admit that I missed the original headline.  I was busy in FL at the Users' Conference.  But here it is:

UnitedHealthcare Buys Some Health Net subsidiaries

Bottom line is that UHC picks up Healthnet's business in the northeast.  So, New Jerseyites and New Yorkers, remember that awesome UHC-Oxford merger?  How'd that work out for you?

A few weeks ago, Dr. Stoller sent me this (and I have just been too swamped to keep up):

An eagle-eyed resource sent me this today:

The underbelly of the insurance industry came into view earlier this year in New York.  Here's a great summary, stolen directly from histalk2.com.  Look at the conclusive sentence:

I have had a number of off-line and on-line requests for details about who, exactly, is paying for the deveopmental testing (96110 and 96111) and non-face-to-face codes (or the "telephone codes"), so Igor was kind enough to look it up for me.

I was paging through my daily Verden Alerts and I noticed that Harvard Pilgrim had released a new set of payment policies regarding E&M codes.  In fact, you can read it here on their WWW site, Verden just makes this a lot easier.  I suspect that most of you are like me and wouldn't normally take more than a second or two to go th