Tag Archives: insurance companies

When Do Doctors Require Medical Transcription Help

It’s scary to be denied health insurance or a job due to a health condition. It gets even worse when our medical records contain diagnoses and treatments for conditions we do not have or never have had. It might lead to a full-fledged denial of insurance or job. Other doctors may even end up misdiagnosing us or prescribing incorrect treatment based on the off beam information in our charts.

How can this happen, you ask?

This usually takes place due to doctors constantly having to authenticate their practices to the dictates of insurance companies. Insurance companies recompense for diagnostic testing and treatments for an ailment or condition, or even a symptom, but they do not rule out a disease or condition.

If one experiences persistent tingling in the hands, feet, lips and ears, few months down the line, one decides it needs to be checked. The primary physician may detect nothing wrong on examining. He may then refer you to a neurologist and may have you get a CT scan done. He may add tingling as the diagnosis, because the symptoms are all he has to go on.

Later, even the neurologist may detect nothing on the CT scan or on examining you but will want you to return for an EMG. He might also send you for an MRI to rule out multiple sclerosis. He may add a diagnosis of MS on the referral and the bill for the office visit, expecting your (very good) health insurance plan to cover tests for a diagnosis of MS.

The MRI might show a possible tightening around a nerve, but this wouldn’t necessarily cover the tingling on only one side of your body. Since you tingle on both sides, ‘pinched nerve’ isn’t really the correct diagnosis for you. But they’ve ruled out MS.

When you return back to the neurologist, expecting the EMG, he tells you that you must have carpal tunnel disease, because you spend your days working at a computer. That’s exactly what he must be looking for, so that’s what he finds. He completely ignores the tingling in your feet, earlobes and lips. And thus, carpal tunnel disease is added to the list of diagnoses on your medical record.

Your health insurance company now assumes that you have MS, a pinched nerve and carpal tunnel disease. That’s because it’s in their records of the claims filed for your medical bills. You will have none of these. You may have a mild tingling.

The incorrect diagnoses gets compounded, because the office clerk sees MS and carpal tunnel from the prior visits and puts that on all subsequent referrals and bills. It came from the doctor, so the question arises that why should it be questioned.

It would be very easy if we needed to apply for a private, individual health insurance plan.

Knowing the neurologist had tunnel vision about carpal tunnel disease, you may move on to another neurologist, who may confirms there’s no evidence of carpal tunnel or MS. At this point, he may detect some mild loss of temperature sensation, but has difficulties coming up with a firm diagnosis and so uses ends us using ‘peripheral neuropathy’ as his diagnosis. All ‘peripheral neuropathy’ basically means is that there’s something odd going on with your sense of touch. It’s a catch-all term that your symptoms fit into. It’s not as good as a diagnosis of a disease, because it suggests no treatment plan or prognosis. Insurance companies might cover testing for it. However, it may turn out better than a lot of incorrect diagnoses on your medical record, because you can be least assured that it is accurate.

It would make perfect sense for the insurance companies to just accept ‘rule out’ diagnosis codes and to pay for charges incurred for them. Because, the whole point of diagnostic testing is to find out what the problem is, and that very often involves ruling out certain possibilities. Another solution for doctors is labs, etc. to just use the diagnosis codes for the symptoms the patient is reporting. In this case, ‘tingling’ could be second-handed as the primary physician wrote. Or the physician could pick a generalized descriptive diagnosis like ‘peripheral neuropathy’ as the second neurologist did.

Unfortunately, patients cannot count on medical providers to do this. One has to have a look at what’s on the bills and in the records. Most of us wouldn’t know what the diagnosis codes meant.

Technology helps, because both procedure (CPT4) and diagnosis (ICD9) code translators are now on the Internet. With EHRs (electronic health records, the patient’s medical records) are becoming more available. This will enable us to see all the details right in our records. If we come across an incorrect diagnosis, we could then insist that we want it corrected.

We need to be meticulous about this if we don’t want incorrect medical information to take over and give us results in denial of coverage or in causing our physicians to miss a diagnosis or give the wrong treatment.


Health Care Bill Simplified On The Back Of A Napkin (SLIDESHOW ANALYSIS)

Interesting concepts are always welcomed, specially when they arise out of globalization and internet connectivity, a colourful representation says with us for long. Dan Roam and Anthony Jones came up with this visual creation to throw light on the sensitive topic of health and portrayed it very effectively.

Check out our analysis of the slideshow below:

#1 – Healthcare in America is a BUSINESS!!

Napkin one states that most of the money in America comes from the health care. It further states that there is a close relations between the patient, doctor and the insurance guys.

But in the last couple of years, the insurance providers have taken the place of decision makers. This happened because health care has two aspects- doctors and insurance. Where one gives health, the other pays for it. The money and health is now in the hands of the consumer due to heavy competition.

Payment of insurance on time helps in the long run. With insurance one can cover many costs like doctors, medicines, products and services. This gives us a sense of security.

However much the insurance guys and doctors hate each other, they eventually have to admit the fact that they themselves are the source of income and business for each other. That’s the irony. Sometimes between these rivals, the consumer pays the price as he/she has to accommodate both the parties.

It is in times like these that the government comes into picture and most of the changes made are towards the insurance providers. The doctors in such cases go usually untouched.

#2 – What is Healthcare Reform all about?

When government makes changes, the reform is not that of the health care initiative but that of the insurance. Insurance companies also have to pay the share holders.

Their suffering shows when the world is blooming. Most insurance companies did well in those times when others jobs were at stake in the year 2008 (recession period).

Insurance providers complain that when a reform takes place, they are the ones who have to go through more hardships because these companies are made to adjust the most. They argue that they are to be paid for the reforms that do not benefit them as much.

#3 – What are the plans on the table?

The word care displays humanity, but not in the case of insurance companies. Health care in America is anything but charitable. It has turned extremely commercial and will show more profit oriented intentions in the years to come.

The public insurance holds the first place followed by private insurances which is then followed by restrictive private insurances. Insurance companies face a problem when the prices go up because insuring everyone means their costs go up. This in turn results in a competition with the co-operatives. It thus results in decreased in the numbers of customers who were willing to pay.

This also leads to government interfering.

Napkin #4 – Politics aside, what do the options me to ME?

The common man has to pay more even if presently employed and insured. So why reform? Because if we do nothing, it’s going to cost even more. People are concerned that reforms will bankrupt the USA. They need to recognize that health costs are already bankrupting us.

In the end, how we each decide to support reform will be guided by 3 questions: Should health be Change is coming; Will I be better a profit-driven how do I want to off shouting or business? pay for it? thinking?

Acroseas’ View

A very clear and concise description and explaination of how the Healthcare Industry functions in the US. Anyone doing business in this industry, even if they are experienced would do well to go through this very simple, yet surprisingly effective, presentation. Its worth your while.