Posts

The Confused Parent’s Guide to Health Insurance

Meet Dr. Chad Hayes.  He’s a solo pediatrician in SC with an interesting path to pediatrics who happens to write a particularly interesting and well-considered blog (yay, English majors!).  He showed up on SOAPM a while back and endeared himself quickly to the sometimes-unreceptive audience there through the high quality of his posts and positions. …

Egregious Insurance Policies (Thanks, Budd!)

A few weeks ago, there was a challenge on the SOAPM list to come up with the Top 10 Most Egregious Insurance Company Behaviors.  Dr. Budd Shenkin compiled and edited the list which, in the draft you see below, I find quite impressive. Of course, I’d love to hear of any additions you might have …

Single Payer Bogey Man

For the record, I’m not in favor of a single-payer system.  But I’m also not a fan of much of the rhetoric that I hear against the concept. In particular, I have always wondered why those advocating for the strength of choice aren’t presently railing at the lack of payer choice for both physicians in patients …

Shame on Horizon BCBS of NJ

It started when Susanne Madden sent me this “nice” message from Horizon to help me warn our clients about games Horizon continues to play.  Bottom line: they expect to stop paying for -25 or -59 modified codes starting May 10, 2010. Two minutes of email exchange led the helpful Dr. Stoller to send me this announcement from MSNJ. …

H1N1 Admin Reimbursement

I had grand plans to keep track of all the different payers and publicize/shame many of them, but by the time the data came in…it was too late. Still, how have PCC clients fared with the new H1N1 administration code? Better than I would have guessed. The bottom line is that PCC clients averaged $14.90 …

UHC Buys Healthnet -D’oh!

OK, I admit that I missed the original headline.  I was busy in FL at the Users’ Conference.  But here it is: UnitedHealthcare Buys Some Health Net subsidiaries Bottom line is that UHC picks up Healthnet’s business in the northeast.  So, New Jerseyites and New Yorkers, remember that awesome UHC-Oxford merger?  How’d that work out …

Oxford Shenanigans

A few weeks ago, Dr. Stoller sent me this (and I have just been too swamped to keep up): “OXFORD:  ALERT! Recoupment Requests Based on Extrapolation Some members have received letters from Oxford requesting that they pay large alleged overpayments based on extrapolation. Members are urged to alert their office staff to be aware of …

Red Alert – Changes to First Data Bank AWP!

An eagle-eyed resource sent me this today: We received information from First DataBank that it was no longer going to include the FET in its AWP calculation. We monitor the pricing publications and noted that the First DataBank AWP for June reflects that the excise tax is no longer included. For those of you who …

A Concierge Practice Beatdown

The underbelly of the insurance industry came into view earlier this year in New York.  Here’s a great summary, stolen directly from histalk2.com.  Look at the conclusive sentence: A NY physician, concerned by the number of patients losing their jobs and health insurance, begins offering patients a flat $79 a month fee that covers unlimited …

Who Pays For What? Today: the 96110

I have had a number of off-line and on-line requests for details about who, exactly, is paying for the deveopmental testing (96110 and 96111) and non-face-to-face codes (or the “telephone codes”), so Igor was kind enough to look it up for me. As an aside, PCC allows our customers a great deal of flexibility when …