Patient relations, where we must proactively take steps to calm a predictably angry patient base, has become a time-consuming, routine task at our primary-care micro-practice. The reason is always the same: The nonsensical policies and actions of commercial payers. Last month we sent this letter along with bills for services, some of which took place over a year prior. The letter was designed to keep the angry phone calls to our office to a minimum while promoting prompt payments. It worked! We didn't receive one angry phone call and 90 percent of the bills mailed have been paid.
We share the letter here with you. Repurpose this as needed at your practice:
At well exams, I give a number of routine screening tests including one for vision. These screens are a part of the American Academy of Pediatrics' Bright Futures recommendations for preventative pediatric care and are considered the gold standard in preventative care. In fact, Bright Futures is so widely accepted and recommended that the 2010 Affordable Care Act names it specifically as the services qualified health insurance plans must cover.
In 2015, your insurance plan failed to pay us as well as the over 300 other primary-care physicians in Massachusetts for Bright Futures services. Several advocacy groups in the state worked hard to convince your insurance plan that they were violating the law by not covering some of the screening tests and, as of today, have been successful in changing some of your insurance plan's payment policies.
At the end of last month, your insurance plan reprocessed all well exams from 2015 and, as a result, they are now paying for routine vision screens (CPT code 99173). What's frustrating, however, is that some families are now being required to pay a copay for the screen. About half of all the reprocessed claims resulted in a copay (the other half resulted in your insurance plan paying us more). We have asked your insurance plan repeatedly why this is and have yet to receive a good answer. This is especially frustrating since, in some families, one sibling might owe the copay, where as another does not.
Per the terms of our contract with your insurance plan, we are obligated to collect from patients whatever the insurance plans states you owe. Thus, you are receiving a bill today for a copay from a vision screen in 2015.
We will continue to push your insurance plan to either fix this or explain why they are charging families the copay. In the meantime, we are obligated to collect from you.
As always, my staff and I are happy to answer any questions, although when it comes to why your insurance plan is passing charges onto you, we rarely know the answer. Your best bet is to contact your insurance plan directly.
Terence R. McAllister, MD