Tuesday, June 13, 2017

From the mailbag: How Many Doctors Does It Take...

From a reader:

"I've ended up with a herniated disk. Been to my regular doc, who referred me to an orthopedic surgeon, who referred to a pain management outfit for an epidural (this is Readers Digest version). Anyway, I'm wondering why this process has so many steps and is taking so long, and if it’s “normal.” Any thoughts?"

Well first, Thank You for reaching out to us, we're always happy to help our readers as best we can. Second, we're very sorry to hear about your pain issues. To answer your question, is what is happening to you normal, yes it is. If it seems complicated, it is complicated.

As to why it seems so complicated, that came about primarily because of insurance. Before carriers convinced doctors that it would be better for the doctors to bill them directly (instead of patients paying doctors and then putting in paperwork for reimbursement), doctors were primarily General Practice or Surgeons, with a few specialties. Fast forward to today, all doctors have a Taxonomy Code (one of about a dozen different ID numbers that are needed to bill for medical care). This is a code that tells insurance companies the doctors’ area of medicine, i.e. General Practice (PCP), or a Specialist and what type of specialist. Within specialties are CPT (Procedure) codes and ICD (Diagnosis) codes that are linked with that specialty. For example, a PCP cannot bill a Massage Therapy code, even if the PCP did massage therapy on a patient; that is not listed as an area of expertise. That is why you need to go to different physicians to narrow down whom is best for what you need done.

In your case, while seeing an Orthopedic is normal for your condition, that doctor would only continue with you if you were to have a surgery. For non-invasive pain management, i.e., an epidural, this is done by another specialist, usually an Anesthesiologist that has special training in pain management. Often times these types of doctors will work in orthopedic offices as a service offered to patients.

I understand from a patient’s point of view it does seem to take longer; however, in our world we are working at warp speed. The problem is that there are fewer doctors and more patients, so it is harder to get in to see a doctor. Also, from now until the end of the year is our “busy season”. People think/feel they have met their deductible, but with 40% of all patients on high deductible plans, the old saw of meeting your deductible mid-year is a false narrative that unfortunately many still hold as “truth.” So in addition to having to see several specialists, you can experience delays due to the fact that right now demand is higher than supply.

The best time to get medical care is 1st Quarter. Most doctors run very slow.

As to the bureaucracy, yes, there are tremendous hoops that doctors must go through for any type of treatment. The biggest is getting the Prior Authorizations demanded by insurance companies for even the smallest procedure and/or medication.

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