Insurance

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

I have tried to get a little more information about the new appeals process being put into place by the signatories to the Love Settlement (you can read details here) but I am still not clear on a few things.  I am told by someone who is heavily involved in this process in NC that the new fee-based reviews are “a great opportunity to physicians to address billing and coding issues which h