insurance piracy

maggles's picture

SOrry to bring this here as I think in fact I'm probably more privileged than many here in terms of health care. But damn it is really rough to be running my mental healthcare business and dealing with insurance co-s, along w/ being on the patient end. Just a little vent/run down:
I have a patient who needs more help from me than any other- lots of outside session help and propping up, which I do, w/a true heart. But it is not easy. This past year since he started w/ me is his first time staying out of the hospital numerous times. So you'd thinkt he insurance woudl think "Gee, this therapist is really saving us money." the way they respond is to make it almost impossible for me to be paid. Every month kicking back the exact same superbill for bogus, erroneous reasons that require me to call and point out their error, which after 1/2 hour of calls they reneg on "Yes, you were right, all your dates of service ARE on the bill, sorry the last claims officer wrongly denied the claim..." etc. It really feels like they want to drive me insane so I just say "Never mind. I give up on this patient, I just won't give him care." THe latest is that they say that they decided to stop his treatment w/out every 12 week reports from me, so are denying $1000 of payments I'm owed right now. I say "How would i know you made this change from unlimited sessions to this proviso? I received no written correspondence on this?" they say "You could go on our website to see what changes we make." "But I am not a preferred provider therefor have no access to your site." "Oh well," they say. Literally. Meantime this patient is doing GREAT and t otally depending on our therapeutic relationship to stay this way for the moment (coming out of serious darkness). I am disgusted beyond words- I have no money to pay anyone until the 16th and am in serious jeapardy because I was told a week ago "Your check is in the mail" and have waited only to be told this week "Oh, actually we are NOT paying you."

Meantime I called my own insurance carrier recently to say "Our premium went up $160 suddenly, can you really do that w/out informing me in writing?" Turns out that they raised it erroneously- was not supposed to be raised til June and yes, only w/ written correspondence. "We are so sorry, will reiumburse you the months you overpaid and reset the auto pay you do each month to the correct a mount." Now a month later- zero reimbursement AND the wrong amount taken again.

These kinds of things make me feel crazy. ANd I'm not even in dire straits. But have not cash until Friday because of this bs.

It's criminal. Why doesn't Obama reign in these bastards?

Thanks for listening.

Comments

maggles's picture
Submitted by maggles on

On top of all this got a letter from IRS "your business is being randomly audited as part of our national reseach project..." Whcih means I was not flagged for any suspected wrongdoing but still have to cancel a whole day of work to produce cellular detail on every damn thing I charged a couple years ago to my biz. I am so careful/good w/ this- it just makes me sick. "This is just so we can research accurate write off parameters for businesses- but if we find anything we will penalize you..." I was part of their quota on 'Single mothers who own businesses" review. I have to prove my child is my child, produce support checks, etc. I am so OVER IT, go pick on someone else!!!!!!

maggles's picture
Submitted by maggles on

Thanks MF. Well put- of course that's it. Except I will see her no matter what, even if
I get only a small fraction of my fee- I have seen waitresses for $20/session (and was helped by a big hearted therapist when I was on the other end 20 year ago!). I said "I will not drop you no matter what they do." But I won't take any more insurance cases for a LOOONG time, which is their strategy, exactly.

maggles's picture
Submitted by maggles on

I have never taken insurance, and thought I'd try it in these hard times, rather than
turning patients away when my practice had dropped too. It is exactly as I expected, but still beyond frustrating now dependent on the system for my own needs.