By Sasha, aka the Healthcare System’s Worst Nightmare.
Suzi wakes up with a nagging pain on the lower left side of her stomach. It’s not bad enough to double her over. It’s just there, every single day, refusing to go away on its own like these things are supposed to. She figures it’ll pass. It doesn’t. So she does the responsible thing and […]
Suzi opens the medical chart. She already knows she is in trouble. Not because the procedure is complicated. Not because the hospital forgot to send medical records. Not because the insurance company changed the rules again. Because Dr. Know-it-all touched it. Let’s meet today’s patient. Jack Smith went in for a cardiac catheterization at the […]
Jill develops knee pain. Nothing life-threatening. She isn’t headed to the ER, she isn’t calling 911. But every time she takes the stairs, her knee reminds her that something’s wrong. Her primary care physician recommends seeing an orthopedist. Jill picks up the phone, expecting to book something for next week. The scheduler checks the calendar. […]
Jack Smith needs an MRI. His doctor examines him, reviews his symptoms, and orders the test. Done. At least that’s what Jack thinks. A week later, a notice shows up saying the MRI has been denied. No explanation he can follow. No real reason. Just denied. So Jack calls his insurance company, which seems like […]
Jack Smith walks into the medical practice for a regular visit. Nothing dramatic. No red carpet. No thunderstorm. Just Jack, his insurance card, and the hope that grown adults in a medical office know how to read an EOB (explanation of benefits). How nice. The visit gets billed. The insurance company processes the claim. The […]
Let me say something that sounds ridiculous but is completely normal in the United States: your access to healthcare depends on your job. Not your health, not your needs, not your situation. Your job. Lose your job, and you are not just losing income. You are losing your insurance, your medical care, your medications, and […]
Patients believe insurance exists to cover the cost of care. That is a reasonable assumption. It is also a wrong one. The real power in American healthcare has nothing to do with who treats you. It has everything to do with who decides whether you get treated at all. Right now, that power belongs to […]
You think your billing company is the problem. Nope. It is your front desk. But let us back up. Because Holly has entered the building. You remember Holly. She consults. She observes. She generates recommendations in a font size that suggests authority. She has been in healthcare administration long enough to have opinions about everything […]
Chad the Auth Guy is staring at his computer screen like it just asked him to solve world hunger. He’s got eight tabs open. None of them is the AMA’s (American Medical Association) CPT update page. One of them is definitely ESPN. Another is his fantasy football league. The rest? Who knows. Chad’s been assigned […]
Monica, the lead biller, hits submit on a clean claim. CPT 99214. Office visit. Jack Smith has a stomach ulcer, confirmed by the physician. Chart note is complete. Everything is signed. Coding is tight. Submitted at 8:01 AM. At 8:01 and 5 seconds, the denial lands. “Documentation does not support medical necessity.” Monica stares at […]