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I have been watching this thread for the last 2 days. I feel compelled to state that our response to the insurers needs to be that we include all of the insurer’s required elements, for example BC/BS Illinois requires that we state that the exam was done standing (never mind that I told them we do them all that way, I must so state in every report) and recently I even got dinged because I did not explicitly state that I saw no perforators. That’s all fine, i.e., we can and must put in observations that the insurer requires for decisions about authorizing treatment, but we cannot embellish beyond what the images and spectra actually demonstrate. Remember that this forum is discoverable!
I just have to jump up on my soapbox here. (Unless you mistake – this is the “other” Bill)
We of course deal with the insurance issues constantly and over the years have altered our reports in order to streamline coverage determinations (especially with private insurers.) In fact, I admit, we have dumbed down our reports. In an effort to obtain coverage for our patients (not completely wrong), we are basically allowing insurers to dictate and even set reporting standards as opposed having the medical community set these standards. This is completely wrong and I believe will eventually prove disastrous to medicine. We need to create the environment in which the insurers are forced to adapt to medical reporting standards. We should be involving patients more, educating them and requiring the patient to contact their insurers to argue for coverage. Involve the states’ insurance commissioner. Our patients are the customers, not the providers whom insurers have a significant financial incentive to deny coverage. OK - before someone slaps me back into reality, let me admit - I know, I am living in a dream world. Not that one cannot accomplish both, but I still cringe when our reporting verbiage is created to allow coverage as opposed to accurately relaying the findings in the most clinically useful fashion.
William B Schroedter, BS, RVT, RPhS, FSVU
Quality Vascular Imaging, Inc
This is so true.
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