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Started By
Message
Medical field folks - worst insurance to deal with?
Posted on 7/20/17 at 9:27 am
Posted on 7/20/17 at 9:27 am
In my area (SELA) Humana seems to be the consensus. They'll deny payment for literally anything and everything. People's health is a close second.
8
Posted on 7/20/17 at 9:28 am to GEAUXT
Humana seems pretty bad all around.
Cigna isn't great either.
They're all so big now that speaking with a live person in the US who actually knows what's going on is nearly impossible.
Cigna isn't great either.
They're all so big now that speaking with a live person in the US who actually knows what's going on is nearly impossible.
This post was edited on 7/20/17 at 9:30 am
Posted on 7/20/17 at 9:29 am to GEAUXT
Hows UHC? (United Health Care)
This post was edited on 7/20/17 at 9:30 am
Posted on 7/20/17 at 9:31 am to GEAUXT
Not in medical field, but I had Humana in SELA (through Obamacare marketplace) for myself and it was terrible. In 3 years of having them and only using my insurance one time...I had to switch doctors because my old doc apparently knew Humana sucked and they didn't accept the plan I had. And I had to switch pharmacies because my plan only dealt with CVS and Walmart.
Posted on 7/20/17 at 9:32 am to GEAUXT
Denials for bullshite that can be easily corrected - Medicare
But for me, overall, it's AETNA. Too many tiered plans with different benefits within the same network makes accurate verfication a bitch. And to many self-funded plans that are governed by ERISA and not the state of TX. Virtual telemedicine is big for us and they deny at about a 50% clip b/c ERISA doesn't require coverage.
But for me, overall, it's AETNA. Too many tiered plans with different benefits within the same network makes accurate verfication a bitch. And to many self-funded plans that are governed by ERISA and not the state of TX. Virtual telemedicine is big for us and they deny at about a 50% clip b/c ERISA doesn't require coverage.
Posted on 7/20/17 at 9:32 am to 50_Tiger
My group doesn't have too much trouble with united
Gilsbar is one of the best for us
Gilsbar is one of the best for us
Posted on 7/20/17 at 9:33 am to 50_Tiger
quote:
Hows UHC? (United Health Care)
Crappy reimbursements, but very few administrative issues.
Posted on 7/20/17 at 9:34 am to MSMHater
quote:
Crappy reimbursements
This is People's in the new Orleans area. They'll try to get people on at 70% Medicare. That is just insane.
Posted on 7/20/17 at 9:39 am to GEAUXT
I know that I used my dad's City of New Orleans health insurance family plan from HealthSmart by Cigna, and I had issues at every single doctor office I went to. They could never verify the insurance quickly. They would try to charge me the full amount with me getting a refund when they verified the insurance afterwards. Never let that happen. The number on the back of the card was extremely unhelpful. I hated using it.
Posted on 7/20/17 at 9:41 am to GEAUXT
quote:
They'll try to get people on at 70% Medicare. That is just insane.
My UHC 99214 is $86. I shite you not.
MCR in my geo is $110.
Posted on 7/20/17 at 9:42 am to MaHittaMaHitta
quote:
I hated using it.
FYI, for the most part, that's all the office has to work with as well for anything outside of an exam. The plans have become more complex, but all their systems have gone almost completely automated. Verification is a freaking nightmare workflow.
Posted on 7/20/17 at 9:43 am to GEAUXT
All of the above.
Posted on 7/20/17 at 9:47 am to MSMHater
quote:
My UHC 99214 is $86. I shite you not.
And patients wonder why doctors cram their schedules so full...
Posted on 7/20/17 at 10:09 am to GEAUXT
What kind of work to you do to bill 99214s? In derm you can get there pretty quickly with a full body skin exam, surgery and prescriptions.
Posted on 7/20/17 at 10:38 am to buffbraz
quote:
What kind of work to you do to bill 99214s?
General endocrine and diabetes management follow ups. NP's are almost always level 5's but f/u's rarely get there. Telemedicine, U/S follow ups, glucose meter check, etc...
Posted on 7/20/17 at 10:51 am to MSMHater
Most of our f/us are 99212, and 99213 but we bill so many procedures it makes up for it....we get denials all the time from all insurances.
Posted on 7/20/17 at 10:55 am to buffbraz
Trust me, we cuss you derm people all the time for your billing mix! My physician owners wife is a dermatologist as well, so it's allowed 
. It's a different world for the E&M docs.
We do get the occasional thyroid bx, lots of ultrasounds, and nuclear medicine very rarely. But almost 70% of our billed codes last year were 99214's. Contract negotiations ongoing.
. It's a different world for the E&M docs. We do get the occasional thyroid bx, lots of ultrasounds, and nuclear medicine very rarely. But almost 70% of our billed codes last year were 99214's. Contract negotiations ongoing.
This post was edited on 7/20/17 at 10:56 am
Posted on 7/20/17 at 10:57 am to MSMHater
I've been doing derm 9 years and have it down pat now because we do all of our own billing, but it took alot of practice and a summer of Inga Elzy courses to get the hang of it, with modifiers, nuances, minutia, etc of billing. It's easy now.
Posted on 7/20/17 at 11:05 am to GEAUXT
From my experience, it is BCBS. Instead of a central HQ to call for all insurance issues, they have dozens of regional ones. Figuring out who to talk to about what takes more time than getting the insurance situation settled (i.e. verification of coverage, procedure approvals, etc).
Posted on 7/20/17 at 11:27 am to GEAUXT
Medicaid in any form, People's Health, and Humana.
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