Another inane health insurance story

[disneysteve]

I've previously posted some examples of wild things the insurance companies do that drive doctors (and patients) crazy. Here's the latest.

One of the Medicaid HMO plans informed us today that they will not cover our visits if vaccines are administered at the same time that a well visit is performed. Just to be clear, that means that if you bring your child in for their annual physical and they child is due for vaccines, we have to make you come back on a different day for the shots. We can't do them while you are already in the office.

This is NUTS! It means potentially a parent having to take additional time off from work and pulling a kid out of school another time. The result is going to be lower vaccination rates which seems like just the opposite of what the insurance company should be striving for.

I have no idea what they're smoking when they make rules like this.

[asmom]

That's nuts. Immunizations should be part of a well-child visit, and should be encouraged. Why would they want to put up a barrier to vaccination? I would love to know the rationale for that decision.

[disneysteve]

I would love to know the rationale for that decision.

You and me both. My biller called to verify it since it seemed so completely backwards and that's what she was told. She is working to verify it because we can't believe it is actually true.

[Retired To Win]

Well, that's one piece of idiocy at least that Meidcare doesn't seem to share with Medicaid. Flu vaccine shot, pneumonia shot, whatever... I've always been offered the option to get vaccinated during my physical check-up visits.

Go figure...

[Nika]

And your patients might think that you are trying to make more money off them by making them come in twice.

[snafu]

Would it work reversed, the visit for vaccination followed by a 'well visit' with another concern? Does your AMA advocate on behalf of physicians? Can you ask for clarification?

[Joan.of.the.Arch]

That is plainly stupid!

Do Medicaid patients with that HMO have a co-pay for every office visit? So that the HMO is trying to get patients to chip in another small amount, so that the HMO doesn't have to?

[kork13]

I would look at the possibility of simply stacking two shorter, separate, back-to-back appointments if it's known that vaccinations are due... That would separate the two "visits" for billing purposes, at least... (besides, of course, actually getting the policy fixed/clarified) Inane, for a certainty though...

[disneysteve]

o Medicaid patients with that HMO have a co-pay for every office visit?

No copays on Medicaid so that's not an issue.

I would look at the possibility of simply stacking two shorter, separate, back-to-back appointments

That doesn't work. The visits would have to be on separate days.

Of course, a doctor could do everything at one time and "pretend" it happened on separate days and bill accordingly. Not that we would ever think to do that.

[Gailete]

Steve, after dealing with Medicare D and the wildly fluctuating costs in a plans formulary each year, every year now for 8 years I have had to switch to a different plan and due to this plan I'm on and the end of the other one I'm actually out of medication currently.

Anyhow, this is my vision of the insurance execs. They are sitting on a first class yacht, wearing finely tailored suits with 100% silk ties that run about $500 each, sipping the finest champagne and saying, 'okay how can we screw them over this year?' Those guys have plenty of money so medical bills are no problem to them, but patients are just pieces on their chess boards of life and their goal is to make even more money while yanking it out of our empty pockets. Only lint is left there now!

When my kids were little (early 80's) vaccines weren't covered by insurance. I couldn't understand why an insurance company wouldn't be willing to pay $5 for a vaccine but would be willing to pick up all the costs of child contracting polio! No logic there for sure. As someone that was born before polio vaccines were available, I knew and went to school with children that had been permanently disabled from the disease. I remember standing in long lines to get my sugar cube with a drop of vaccine on when I was about 5. Okay I'm ancient but health care has come a long way and this policy just makes it go backwards instead of frontwards.

[creditcardfree]

If this ends up being true, I would call your Congressman. They need to know this!!

[NetSkyBlue]

That's NUTS! I just had a physical last week, and my doc gave me a tetanus booster at that time, "since I was already there." There's no way I would have rearranged my schedule again to make it to the doctor solely for that.

I actually DO have an appointment to go back next week for a cholesterol screening, but we couldn't do that the day of my physical since I had eaten that day. My first was an afternoon appointment and I had no intention of fasting all day!

[ua_guy]

Interesting. Are they doing it based on date of service? Couldn't you just schedule a 10 minute no-charge visit for vaccine-only following an E&M visit while the child is still in the office (and charge separately for the vaccine and administration as part of a different encounter?

[disneysteve]

Interesting. Are they doing it based on date of service? Couldn't you just schedule a 10 minute no-charge visit for vaccine-only following an E&M visit while the child is still in the office (and charge separately for the vaccine and administration as part of a different encounter?

I'd have to check but I'm pretty sure that you can't submit two bills for the same date of service.

We're still waiting to hear back from the Medical Director to verify that what the phone rep told her is actually true. We all suspect it was a mistake.

[Sinbad43]

Wow. This doesn't make sense to me. Why should you have to have an extra appointment, wasting time, money and effort, to do something that is easily incorporated into the existing one?