Re: Dilemma #3

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>IN>In a message dated 97-08-22 14:01:47 EDT, (Michael
>IN>Sachs) writes:
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>IN>> 1) cave in, or do I
>IN>>
>IN>> 2) have my staff gently explain that their insurance only covers visits
>IN>> every two years at his age (which is my standard) and I know a nice
>IN>> pediatrician in Long Island who would be happy to assume his care after
>IN>> they move!
>IN>>
>IN>I don't know if it would work with that family,but we've used #2 for several
>IN>insurance-related problems. We tell them that their insurance company no
>IN>longer covers ___________. This ranges from lab tests to freezing warts to
>IN>suturing lacerations in the office. (I still can't believe the insurance
>IN>company would rather have me send the patient to the ER for suturing a simpl
>IN>laceration).
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>IN>Moshe Adler, MD
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>I am a pediatrian nurse and mother. I would suggest letting the family
>know that the insurance will not cover the visit, but you'd be happy to
>see them. Arrange (with charges as apprpriate) to have a copy of their
>records ready and the names of two or three pediatricians in their new
>area. It is frightening to be in a new area and not know who to call if
>your child is sick. Having copy of the chart readily available and a
>recent physical should make the new pediatrician more comfortable if a
>minor illness (strep throat, ear infection etc. ) needs to be treated
>right away. Think about how you feel when a new patient calls you for
>treatment and you don't know anything about them.
>
>Patricia Dyer, RNC
>Albany, NY
>

This brings up a good question I've not seen addressed previously: charging for copying medical records. We never do for a routine change to another office (for whatever the reason), or if a consultant needs the notes. We have on occasions when a family changes, then calls at some future time saying they need the records again and can't get them from the interim office (which usually means that that office does charge). One trick for complex patients who might have multiple offices or consultants requesting the chart: give a single copy to the family (with updates as necessary) at no charge, and let them be responsible for distributing all subsequent copies.
And what about insurance companies? We'll get reimbursed when a company requests complete records for the purpose of determining insurability when a family applies for a new policy, but what about when a company requests office notes to determine benefits for one or more office visits? Especially if it's a contracted PPO which can sit on the claim forever until they get the requested information.
What do the providers out there do for families or insurance companies?

Regarding referring a family to a new doc before a move: I really don't know pediatricians outside of L.A., so I'll copy a page from the AAP directory if asked, but that's not much different from looking for "FAAP" in the local yellow pages. I usually suggest asking a family member or friend in the new area, and if they don't know anyone I suggest they start looking around quickly. My patients also know they can always call after they move and I'll do what I can over the phone if they don't have a new provider yet (and sometimes even after they do). And although having the chart is of course nice when seeing a new patient, we all see new patients, families on vacation, etc. and frequently have to just wing it.

Michael Sachs, M.D.