PRACTICE DIARY

Chapter 28

 


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Fam Pract Manag. 2001 Sep;8(8):52.

The clavicle: part III

The itemized hospital bill for my son’s recent minor surgery arrived last week, and it was an eye-opener, to say the least. Among the more interesting charges, there was a $2,073.15 charge for the first hour in the operating room (Gabe was only in there for 15 minutes), then a $695.85 charge for the recovery room (a half hour) and another $298.15 for observation services. (Gabe was in and out of the place in less than two hours.) A “Cart, Ortho-Major” was billed out at $3,138.35 (since forceps were all that proved necessary to pull out his spiculated bone fragment, using the cart seemed tantamount to chartering the space shuttle to take you out for bagels on Sunday morning). But I didn’t despair because I had primary health insurance, and they were stingy. I knew my insurer wasn’t going to cough up 3,000 bucks for a cart of every sterile orthopedic instrument in the hospital unless the surgeon was making a bionic man. The hospital would be lucky to get $1,500 on that travesty of a bill. Besides, I also had secondary health insurance through Gabe’s school, which was supposed to cover his $2,000 deductible. I was sitting pretty. I figured to spend $100 out of pocket, tops.

The EOB came today. It said, “Total Billed: $7,113.66. Amount Allowed: $0.00. Patient Savings: $7,113.66.” The message read, “In order to be eligible for benefits, claims for this provider must be submitted within the time frame specified in the provider contract based on the hospital discharge date.” In short, the hospital had waited too long to bill my insurer and had exceeded the statute of limitations! I called my insurer and found out that hospital providers have 120 days from the service date to submit a bill to the insurance company, and they hadn’t. “Is this a rare occurrence?” I asked the claims rep.

“Between us,” she said, “it happens all the time.”

“No wonder you guys are rich,” I thought.

Then, a horrifying idea crossed my mind. What if the hospital, after getting zero dollars from my primary insurer, billed my secondary the full amount? And what if, instead of chopping them off at the knees, this insurer was more generous and allowed nearly all of it? Since my secondary insurer paid only 80 percent of the allowed amount, I would be responsible for the rest. I wasted no time in calling their claims rep. He too explained that there was a 120-day statute of limitations on billings (great!), but since their company dealt mostly with college students who couldn’t seem to do anything on time, they usually cut the providers some slack (damn!). He already had the claim, so I asked him whether they were going to pay $3,000 for an ortho cart to take out a splinter. “That does sound excessive,” he said and suggested I send all the EOBs in my possession to him and he would expedite their processing. “It’s an interesting situation,” he said.

“Interesting?” I said. “It’s pathetic. If I ran my office like some of your providers run their businesses, I’d be declaring bankruptcy by now.”

My business friend, Charlie, is right. It’s less stressful to be sick than to try to deal with this miserable system.

Herbal medicine

For years I’d been telling patients who wanted to stop smoking to chew licorice root. I’d read some convincing literature on the subject, but as far as I could tell, no one took my advice. Then, not too long ago, a patient came in with what looked like a twig in his mouth and a small paper bag in his hand.

“What’s that?” I asked.

“That’s the stuff you told me to get to quit smoking, doc,” said Norm.

“Oh,” I said, surprised. “You actually took my advice and got some licorice root. It’s been so long since a patient came in with it that I forgot what it looked like. How’s it working?”

“Great,” Norm said. “It took away my craving for tobacco and gave me something to put in my mouth besides. And it’s dirt cheap.”

Inspired, during my lunch hour I went to the health food store and bought up all the licorice root they had. “You’d better buy more of this stuff because I’m going to be sending all my nicotine addicts here for it,” I warned Stan, the proprietor. For the next several weeks whenever a patient came in reeking of cigarette smoke or wanting to quit, I’d say, “Here, put this in your mouth and chew on it. What does it remind you of? Nothing yet? Keep it in your mouth for a while.” By the end of their exams, some of my patients could detect the faint taste of licorice.

“OK,” I’d say, “your prescription is to get a bunch more of this stuff and put one into your mouth whenever you crave a cigarette. I don’t know whether it will work better than the patch or nicotine gum or Zyban, but this whole bag only cost me 60 cents. So, if it doesn’t work, you can take the money you’ll have saved and go get hypnotherapy or acupuncture.”

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many characters, stories and lessons family practice has to offer. No real patient names have been used. Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.


 

Copyright © 2001 by the American Academy of Family Physicians.
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