You’ve gone to a nice restaurant for dinner, and after a good meal want chocolate cake. The waiter tells you, "Sorry, we can’t serve both at the same meal. You’ll have to come back tomorrow for dessert." You’d be surprised, maybe angry, and definitely not inclined to go back there again. Yet, doctors do that EVERY DAY in the United States.
Declining reimbursement gets all the insurance attention, but there are plenty of stupid rules. My personal peeve is the one that won’t allow certain tests be done on the same day as a patient visit.
Courtesy Wikimedia Commons/Politikaner/Creative Commons Licensehoto Credit
Take an electromyogram/nerve conduction velocity study. I see a patient in the office. He has a fairly straightforward case of carpal tunnel syndrome, and so the immediate course is to confirm it with electrical studies. BUT, under most insurance guidelines, I can’t do the test on the same day as the consult.
Even if I have time to do an EMG/NCV during the visit or had a new patient cancel so I can see this guy back for the test that afternoon, IT’S NOT ALLOWED. So I have the options of either billing for the consult or test (not both) or having the guy come back another day (which is what I do).
I honestly don’t understand this because:
• It costs the insurance company the same amount (roughly) to split it up on 2 days instead of 1.
• It helps other patients, because now I can use the hour I’d have spent on his EMG with them.
• It helps my bottom line (all done in 1 hour, instead of 2).
• It’s good for the planet (less gas burned driving back to my office for the test).
• Most important, IT’S GOOD FOR THE PATIENT. He has his test results back, so we can move on to the next step, instead of waiting a week for the study. It also saves him a copay, since he only came in once instead of twice.
To me this is common sense. But to most insurance companies, it’s fraud.