More insurance company nonsense

Let me start out by making it very clear that I am more laughing than complaining here. I make a great living and am not complaining about my job at all. I love what I do, and am happy to give back. That being said, some insurance companies are truly insulting….

Recently I got a call from the Emergency Room with a young girl who had cut her lip wide open. I got on the phone with the Emergency Room doc who told me that this was far too complicated for him to handle.

My answer, ok I’ll take care of it. 30 minutes to get to the ER. 30 minutes to repair the laceration. 30 minutes to get home. Several follow up visits for suture removal, scarcare techniques, etc..

So, the claim was submitted to her insurance company. It happens that this was a managed care Horizon medicaid plan. This is the type of insurance plan medicaid managed by insurance companies like Horizon.

This week the claim was paid. The total payment $45. That’s right, forty-five dollars. This is a claim that should have paid $1500 at the very minimum by any commercial insurance company.

Let’s think about this: I can’t get an electrician, plumber, or pretty much anyone to come out to the office to repair something for less than a $125 service call fee. $45 for a laceration that was so complicated that the ER doc who sutures things all day long couldn’t handle.

What plastic surgeon can afford to drive to and from the hospital for an hour, take 30 minutes to repair something, provide quality aftercare for $45. It is truly ridiculous. While the money I get paid for by my cosmetic practice makes it affordable for me to lose on cases like this, it really shouldn’t be this way… I would rather be paid nothing and chalk it up to “just doing the right thing” than to be insulted like this….

Politicians complains about how expensive medicaid is to the state and what a financial burden this imposes on society. Perhaps the hospitals are paid well by these plans (I really do not know) but they certainly aren’t shelling out big bucks to doctors for the care they provide to these covered patients. At these reimbursements it is no surprise that plastic surgeons quickly become resistant to providing needed care for these insured groups. In addition it certainly is something that makes me want to think twice about taking Emergency Room call.

Luckily my New Jersey cosmetic surgery practice does very well and 99% of my practice is cosmetic so I don’t have to do anything other than laugh at this insulting payment, but it certainly makes one wonder where all the dollars are being spent!

Leave a Reply

Your email address will not be published. Required fields are marked *