This is a comment rather than a question. I work for a group of Radiologists. Other doctors order the exams, while our docs provide the service and hope they get paid. The exams are ordered many times because the patient expects something to be done or the referring doctor is afraid of being sued!
I have been a medical coder for 14 years and the denials from insurance companies increase daily. I have seen a huge increase in correct, payable claims denied. One example is that a patient and I fought for 5 months to get a simple screening mammogram paid for. Every woman over 50 is entitled to a screening once a year. This woman met EVERY requirement and the claim was billed correctly. When the patient threatened to get a lawyer involved they hung up on her. After I told them if the claim wasn't resolved I was sending it to the insurance commissioner, they finally admitted the mistake was on their end and paid the claim.
It was on the news a year or two ago that one VERY LARGE insurance company pays their people a BONUS! for delaying claims for 30 days. Can you immagion the money they save by that! This as well as denials of correct claims drive up the cost of medicine for ALL of us.
Medicine is the only industry that I know of who provides a service and a third party determines whether they get paid.
Hi Trisha,
This is a comment rather than a question. I work for a group of Radiologists. Other doctors order the exams, while our docs provide the service and hope they get paid. The exams are ordered many times because the patient expects something to be done or the referring doctor is afraid of being sued!
I have been a medical coder for 14 years and the denials from insurance companies increase daily. I have seen a huge increase in correct, payable claims denied. One example is that a patient and I fought for 5 months to get a simple screening mammogram paid for. Every woman over 50 is entitled to a screening once a year. This woman met EVERY requirement and the claim was billed correctly. When the patient threatened to get a lawyer involved they hung up on her. After I told them if the claim wasn't resolved I was sending it to the insurance commissioner, they finally admitted the mistake was on their end and paid the claim.
It was on the news a year or two ago that one VERY LARGE insurance company pays their people a BONUS! for delaying claims for 30 days. Can you immagion the money they save by that! This as well as denials of correct claims drive up the cost of medicine for ALL of us.
Medicine is the only industry that I know of who provides a service and a third party determines whether they get paid.
Thanks for listening to the flip side!
Pam M