Ask a Gastroenterologist is a weekly series of questions posed to GI physicians around the country on business and clinical issues affecting the field of gastroenterology. We invite all gastroenterologists to submit response
Next week’s question: What is the best way for GI physicians to select new partners for their practices?
Please submit responses to Carrie Pallardy at cpallardy@beckershealthcare.com by Thursday, Feb. 11, at 5 p.m. CST
Allen Kamrava, MD, MBA FACS, Associate Teaching Staff, Department of Surgery, Division of Colorectal Surgery, Cedars Sinai Medical Center (Los Angeles): Having patients understand what to expect on the insurance side of things. More specifically, what they hear from the insurance company is often times in stark contrast to what happens in reality. And if anything is off, they blame us.
For instance, trying to get a patient to understand that a screening colonoscopy is “covered,” but if we find anything that needs to be biopsied during the procedure, insurance may no longer consider it “screening” and the procedure is no longer “covered” in the way they consider it. Or, the insurance company tells the patient anesthesia is covered – that is as long as the physician fills out a form stating “medical necessity.” What they do not explain to them is that the insurance company may ultimately deny that it is a medical necessity, regardless of the form, and then the anesthesia will not be covered.
When we try to explain this before the procedure, they do not necessarily understand this. And if they get “surprised” after the procedure, they blame us for whatever the insurance companies have independently decided. The insurance carriers have been masterful at shifting blame towards the practitioners on most everything.
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