Fraud in medicine: Veterans Choice

Yesterday I tried another tack to get paid for seeing Veterans Choice patients.

We are more than 40 miles from the nearest Veterans Hospital. Starting May of 2015, I was called by the Veterans administration to ask if I would accept a veteran as a patient. I said yes. I have seven by now, but we are currently refusing to take more.

That is, I can see them, but so far I have not been paid a penny.

The VA sends me an authorization from Triwest, the (for profit) contractor in the Northwest region, I see the patient, I fax my note and everything to Triwest, I fill out forms for referrals…. my biller follows Triwest’s instructions…. and they do not pay us. Over 25 visits now, over $5000.00

I have called Triwest, I have written to my senator and representative, I have called and called….

Yesterday I looked at this site: http://www.va.gov/

From there to the US map: http://www.va.gov/directory/guide/division.asp?dnum=1&isFlash=0.

We are district 20: http://www.va.gov/directory/guide/region.asp?map=1&ID=20

VA Puget Sound Seattle: http://www.pugetsound.va.gov/

Under “about us” a dropdown menu to the leadership team: http://www.pugetsound.va.gov/about/leadership.asp

And I called the office of William H. Campbell, MD, FACHE | 206-277-1330, chief of staff, third one down.

The administrative assistant who answered asked if he was expecting my call.

No, I said and explained. I said that I very much like my veterans and would like to continue to work with them but as the owner, CEO and sole physician in a small business, I do need to get paid. Please help.

She put me on hold. And then I spoke to Dr. Campbell and explained again. I said that I am not getting paid, we have contacted Triwest multiple times and followed their instructions, when I call Veterans Choice the response I get is “I don’t know.” and that my patients can’t get their mail order refills because even though the VA called me to see the patient, I am not “entered” in to their pharmacy system.

Later I got a call from a person who promised to speak to Triwest and expedite payment.

I got a call from the head of pharmacy at the Seattle VA.

Who knows? I might, someday, get a check from Triwest.

The issue is really that this is not an isolated problem. All of the insurances are getting worse. I get postcards from 50 different insurance programs a month telling me how they have changed their benefits for the different plans and inviting me to go on line and read their detailed instructions. Noridian, the northwest for profit contractor for medicare, held my payments for 5 months last year because they were getting audited and suddenly realized that my application and everyone else’s had been wrong for years. Doctors are quitting all over the Olympic Peninsula and I suspect all over the United States. At this point I do not think anyone could DESIGN a more unintelligent, arcane, frustrating system. And if you see a US doctor, half of their staff is there to go on line or on the phone to get prior authorization to get a CT scan, get an MRI, see a specialist. And the paperwork for every lab, every insurance company, every xray, every physical therapy office is DIFFERENT: tell me, is this efficient? No, but someone is making a huge amount of money and it is certainly not me. I want my health care dollar to go to health, not to stupidity and not to corporate profit.

And I am wondering if it is worth it……

I took the photo of the trees and bunkers at Fort Worden in 2005.

 

 

Dream: home surgery

Yesterday I ask a friend to drive me to pick up my son, on his way home from college for spring break, an hour to a nearby pick up point and back. I can’t walk without limping horribly: apparently the recent stress in clinic has made my muscles mad.

F. drives. He has just finished reading Reinventing Collapse: The Soviet Experience and American Prospects, by Dmitri Orlov. Mr. Orlov says that I, as a physician, should start moonlighting as a midwife for barter to have a back up plan for when the economy collapses.

I laugh. “Not very helpful where the median age is 55.”

“Not to mention people want to use their pathetic health insurance.”

Home and I go to sleep. Dream: I am at F.’s house. There are two other men, one of whom needs abdominal surgery. We argue for a long time but he has no money and finally I agree to do surgery with F. assisting. The other man is to help hold the young man down. We do not, of course have anesthesia. I go over what I am going to do, force them to pay attention, discuss sterile technique, boil everything. Not ideal….

We don’t have a cautery or suction either. But there is almost no bleeding and the two things that need to be removed come out easily, I am very very  gentle, so I don’t cause other things to bleed. Never mess with the spleen.

Now I need to close the abdomen and I don’t have absorbablesutures. I am going to do a figure 8 from the surface, in skin, out the abdominal fat, across into the fat, down through the fascia, crossing very delicately up into the fascia on the other side, out the fat, in the fat on the other side and out the skin. Then slowly pull it tight, tight, and tie it off. It’s thick nylon. Nonabsorbable. Usually you would take the nylon out in 7-10 days but I am wondering how long I would need it for the fascia….I thought that would take 6 weeks to heal. I am worrying.

But now F. and the other man are not holding my patient, they are backing off and congratulating each other. My patient gets up off the table. “Lie back down!” I say, “Your guts could fall out the opening! We haven’t closed! F!” Surprisingly his guts are not falling out, but it’s because I have done such a beautiful low abdominal incision, bikini style. “Get back on the table or I will make you go to the hospital to have it closed!”

He reluctantly gets back on the table. F. and the other guy are still being morons but are calming down….

….I wake up.

 

The photo is in my yard during sunrise last summer: spring forward today….

music: https://www.youtube.com/watch?v=aEi_4Cyx4Uw

Fraud in medicine: prior authorization II

The insurance corporations and the culture of business fraud is destroying the United States economy and allopathic medicine.

I am a US physician who calls for prior authorizations myself, with the patient in the room, and bills the insurance company for the time “counseling and coordination of care” by the minute.

I called with patient X, to get authorization for a medicine, last week. We had already tried by me filling out on line forms, twice, and faxing paperwork to the insurance company. Now I was calling them. His insurance card has a separate number for “Rx”, that is, prescriptions. I call the number.

Call 1 takes me through a phone tree, puts me on hold and then hangs up on me.
Call 2 takes me through the same phone tree: enter my national provider identification number, my tax id number, the patient id number, etc. I reach a human. She asks for my number in case we are cut off. I give it to her. I also confirm my clinic address, national provider number, tax id, fax number, patient id number, date of birth, patient name. She will call back if we are cut off. We are cut off. No call back.
Call 3 takes me through the same phone tree. It hangs up on me before we reach a human.
Call 4 takes me…….we reach a human. He takes my number. He promises to call back if we are cut off. Repeat previous information. We are cut off.

No. Call. Back.

Ok. I call the insurance company main number and explain. Meanwhile I am documenting each call in my patient’s chart. The insurance company explains that the patient is in a Union and the Union has it’s own prescription program which has NOTHING TO DO WITH THE INSURANCE COMPANY. I insist that as the patient’s insurance company, they must help. They give me the number of the Union headquarters and put me on hold to transfer me. We wait five minutes. Then we hang up.

I call the Union. I reach a person. I explain that my patient needs prior authorization and we can’t reach the Rx company and we called the insurance company. The Union person kicks it upstairs and swears someone will call me. Tomorrow.

I apologize to my patient for the continued delay. I document in the chart: billing by time one hour face to face counseling and coordination of care making SIX PHONE CALLS TO TRY TO GET PRIOR AUTHORIZATION AND UNABLE TO. I express frustration in my note. I hope the company reviews the clinic note regarding the high bill, because I would be very happy to think that the insurance company might get upset at the Rx company for costing them money.

This is fraud. This costs United States citizens $82,000.00 per provider per year to have people sitting on the phone, on the computer, trying to get prior authorization approval from the insurance companies. The contract that I sign with an insurance corporation to be a “preferred provider” basically says that the insurance company can change their policy whenever they want. There are 500 plus insurance policies. Do you think you could keep up with every policy’s changing rules? I can’t. Nor can my patients. It is in the interest of the insurance corporation to make it difficult and incomprehensible.

I am told that Donald Trump knows how to run a business. I think he does, by US corporate standards, which means that the business is dishonest. I am not in the land of the free and the brave and the independent. I am in the land of corporate dishonesty and lies and I am angry.

I like my patients and I like medicine. But I hate United States business practice: rob from the poor and the sick to enrich the rich.