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This page contains a single entry by Westley Annis published on December 4, 2008 11:01 AM.

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Good Cop/Bad Cop?

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Do doctors use a Good Cop/Bad Cop routine with their office staff acting as the bad cop?

My daughter was recently diagnosed with Reflex Sympathetic Dystrophy (RSD), which can best be described as a nerve signal getting stuck like a needle on a record. It's not a disease and is treated with physical therapy. In an effort to ease pain and make the physical therapy easier to handle, a nerve blocker procedure is recommended.

My daughter's doctor recommended a pain doctor to do a Lumbar Sympathetic Nerve Block procedure. We go see the pain doctor who examines her and agrees the nerve blocker procedure is the way to go.

It is an outpatient procedure, takes about five minutes for the procedure and thirty minutes for the recovery, although it does take 4-5 of these. The pain doctor instructs his billing girl to work everything up for us so we know what to expect money wise and so the problems begin.

Since this is one of those "pain management clinics", I understand that there are several entities all under one roof: the doctor, the facility, and the anesthesiologists. Each is going to have their own bill for the procedure.

The girl comes in to explain what insurance is going to pay and what we can expect out of pocket. She starts explaining about deductibles and tries to tell me that our insurance has one deductible for doctors charges and another deductible for surgery charges.

Like most people, I don't know my insurance policy inside and out, but I have read through it, the BIG booklet, not the Cliff Notes version. Nowhere in my policy could I remember ever reading about two different deductibles. When I mention this to the girl, she tries to explain it away by saying that the insurance companies try to hide that little bit of information and that's why I don't know about it.

When I get home from the doctor's office, first thing I do is go to the web site and pull up the policy. There is no mention of a second deductible for surgeries, but I do notice that the numbers the girl quoted me look a lot like the out-of-network deductibles and co-pays.

The paper she gave us explaining the fees clearly has in-network circled. I start searching the list of providers. I can find the doctor but can't find the surgery center anywhere.

The next morning I call the insurance company, thinking maybe the web site just isn't up to date. Nope, the surgery center is not an in-network provider. I call the doctor's office looking to speak with the doctor, I get a call back from the billing clerk who now starts singing a different tune.

"Oh, we're not in-network but we treat it as if you are giving you the same percentages on your co-pay as if we were in-network."

Very obviously not the same story I heard yesterday.

I now have an appointment with a different doctor. His clinics are also out-of-network, but seem to follow what is a common practice of accepting what insurance pays and only expecting the in-network co-pay from the patient.

Knowing it up front is a lot different than lying about it. Now, to find out why it is common practice for the surgery centers to not join insurance networks but honor the network percentages.


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