Dial C for Coding: The Denouement?
Well, all it took, it turns out, was a simple request for a"copy of the UB04 or the CMS 1500 for the Date of Service" for DHMC to back down (sort of). Pardon me for being a cynic, but it sure looks to me like they caved when it became clear I would exercise my rights under the federal Health Insurance Portability and Accountability Act (HIPAA) to get into the guts of this whole coding thing. This is exactly the kind of backtalk that Dr. Elizabeth Rosenthal recommends in An American Sickness, so thanks to her for the inspiration.
Here's the latest round of correspondence via MyDH:
Hello Donald, Thank you for contacting Dartmouth Hitchcock regarding your account. I will be happy to answer your questions and concerns. My sincere apologies as your file indicates your preferred name is Don. I have reviewed your account with management and the copayment of $30.00 has been adjusted. A coding review was completed on your account and determined to be correct as is. There was a charge for your annual physical exam which had been paid in full by your insurance as well as the additional visit charge in which the insurance left a copayment. I sincerely apologize for the inconvenience. I have printed and mailed the itemization to reflect the account is now at a zero balance. Please be advised going forward any topic outside of the annual physical guidelines will lead to a split visit charge. If you have questions or need additional assistance regarding your account, please respond to this message or call the Customer care center at 1-844-808-0730. Thank you for being a patient of Dartmouth-Hitchcock, Kristy
Dear Kristy: My medical records indicate that my preferred name is "Don" because I prefer "Don" to "Donald" for those who happen to be on informal terms with me, which includes my caregivers so long as they don't mind if I address them informally in return. (Dr. Geishauser likes to be called "Dr. Ben," which seems kind of endearing.) It certainly is not an invitation to the entire bureaucracy of the state's largest employer to address me as if I am a third grader. I realize most hospital employees provide only their first names because they don't want people tracking you down outside of work. Fine, but that's on you. Thank you for reversing the $30 charge. As for the future, please provide me with a list of the the topics that trigger additional charges and at my next annual physical I will hand that list to Dr. Ben and ask him to avoid those subjects. If that's the way DHMC wants to deliver primary care -- well, that, too, is on you. I think DHMC should be ashamed of itself.
My family and I are bigtime customers of the healthcare system. When I checked the Anthem Blue Cross/Blue Shield web site the other day, the company had processed nearly $150,000 in medical claims for us so far this year -- and that does not include prescription medications (which Express Scripts handles). Maybe that seems outrageous? We're a family of six, including one person with a serious chronic illness (cystic fibrosis) and all of us, for good or ill, with at least one health issue or another to confront. In these circumstances, we can't afford to do anything other than demand the healthcare system treat us like loyal customers.
Now, on to drug price negotiation!