Published January 5, 2006 in issue 0501 of the Hook

BY JOHN HONG, MD

Even though customer service is such a difficult job, every business seems to be raising the bar to keep their customers happy and allow their business to thrive.

"This is Amy, your personal banking specialist who cares about you and will fight for every ATM transaction you do, even when your funds are as depleted as the national treasury. How may I be of service to you on this glorious day?"

In almost every business and every field, the customer's best interest is paramount.

What about healthcare? Healthcare is going downhill. Are Medicare and health insurance to blame?

Medicare is decreasing payments for medical services again-- ignoring inflation. Maybe Medicare thinks inflation is something you do to balloons at a birthday party-- or what Donald Trump does to his ego and hair everyday. Because Medicare is dropping reimbursements again, all the private health insurance companies are doing the same because they base their payments on Medicare rates. Is that the "Trickle Down Effect" because it keeps trickling doooooown?

Because of inflation, things like vaccinations cost more, but most insurances are paying less for vaccinations. So at this point, I can't give a simple tetanus shot to my patients. Before you get lock-jaw over this issue, don't' ask, "Why can't I just pay extra to cover the losses?"

Ha Ha Ha...a reasonable question and it seems like a basic right you should have. However, I just learned that the doctor cannot fiddle with reimbursement. Because the doctor is basically an employee of every health insurance company he or she contracts with, if insurance says no payment, there ain't no payment! So my advice to everyone out there is: Don't step on a nail.

In the winter, we bundle up. Insurance companies are bundling up too meaning they say, "Hmm, let's not pay for extra services and just say they're bundled in with the office visit." Have you noticed some doctors won't do a procedure on the day of your visit?

Let's say you feel a tumor in your neck and see the doctor about it. You're worried it's cancer, and you would like a diagnosis soon. The doctor might spend up to an hour with you to ask you questions, answer your questions, examine you, and figure out the plan. However, if he biopsies the tumor during that visit, the insurance will "bundle" the service of doing a biopsy with the office visit-- i.e. not pay for the biopsy or not pay for the office visit. Insurance doesn't even pay for Lidocaine to numb the area for the biopsy, so bring a stiff drink with you and bite down on a bullet.

The story isn't over. Suppose, after the procedure, you see the same doctor for a different issue­ like a sinus infection. If you see the doctor within a certain time period, health insurance often won't pay the doctor for the second visit. That's like being a carpenter, and you don't get paid to renovate the bathroom if you're asked to do it too soon after renovating the kitchen.

"Ah, I know you just remodeled my kitchen, but I won't pay you for the new job on my bathroom, because hey-- good enough for healthcare, good enough for me! Now remodel the bedroom PDQ because I have some guests coming for Christmas."

Once upon a time, patients would see their doctor, pay the bill, and get reimbursement from their health insurance companies. At least patients and doctors could figure out what was best for the patient then. Today, health insurance rules medical care-- completely.

Getting paid by Medicare, Medicaid, and health insurance is as difficult as trying to figure out what figure skater Oksana Baiul is trying to say: "I skate for audience and I love myself and skate to be happy with me, no one else, except audience." I just hope she doesn't get cut on her skate's toepick and need a tetanus shot.

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