Your Medical Insurance and My Practice

September 13, 2008

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Medical insurance payments are based on the seriousness of
your problem, which in turn determines the amount of time a physician is
“supposed” to spend with you on the history, physical examination, planning the
workup, determining treatment, etc.  All
of these factors are standardized for “conventional” medical care – diagnosis
is based on single problems and laboratory and imaging (X-ray, ultrasound,
etc.) results. Treatment often uses prescription drugs or surgery.  According to insurance companies, treating
multiple problems at the same visit does not increase the complexity of the
visit, nor does it increase reimbursement.

 

Preventive medical care is almost never covered.  Any discussion of your health issues must be
clearly related to the diagnosis.  The
most severe and complicated problems (cancer, heart disease, etc.) are
considered to warrant an average of 40 minutes during a re-visit (60 minutes
for the initial consultation) of the doctor’s “face-to-face” time.  Less severe problems warrant even less
time.  In addition, the doctor is
supposed to create and maintain your medical record separately from the
consultation itself (usually at the end of the day, which creates obvious
problems for keeping good records).  Given
all this, it is easy to see why many people feel that their doctors don’t spend
enough time with them.

 

This is certainly not holistic health care in any sense; it
does not allow for any in-depth understanding of the relationship between
chronic medical problems and a person’s life, nor does it allow for any
creativity in diagnosis or treatment.  It
does not allow time to collect information beyond the “problem-centered”
(rather than the “patient centered”) approach of today’s “conventional
medicine,” which so many people are unhappy with.  In my approach, I try to focus on the restoration of health, which may include, but certainly involves more than the treatment of disease.

 

I do not want to compromise the quality of care that I offer
you.  I will submit claims to your
insurance carrier, but I cannot promise that I will be able to “code” our visits
to the full extent of my charges, which are based upon the time needed to work
with you to improve your health (rather than by the diagnosis of the disease).

 

If Medicare is your insurer, you will need to sign an
“advance beneficiary notice” each time you receive services from me, indicating
that you understand these circumstances and agree (or disagree) to receive
“uncovered” services.  There are legal
limits to what I can charge you for “covered” services.

 

If you have insurance through Blue Cross, Aetna,
and most other carriers, please understand that I can only submit codes that
reflect what we do in the office visit according to the company’s criteria.  Although there is no limit to the amount that
I can charge for your visits, they will only reimburse you according to the
terms of your policy and the codes that I am able to submit.

 

Please note that no medical insurance at present covers any
telephone or email consultations, although there are efforts underway to change
that.

Latest Vitamin D

9/13/2008 — Regarding the Vitamin D issues, after reviewing the evidence and the
controversies that I alluded to last time, I think that for all but a
few people, the evidence is very strong towards making sure that
Vitamin D levels are adequate.
For most people, this can be accomplished with adequate sun exposure in the summer time.

For people with Sarcoidosis (a rare disease), lowering Vitamin D levels may be advisable.
For people with Chronic Lyme Disease, vitamin D levels need to be
studied individually.  This is a serious medical condition and there
are some patients who appear to have been helped by the Marshall
Protocol.
For those of you with autoimmune disease, it would appear that adequate
vitamin D is beneficial.  There are still some unanswered questions but
not enough evidence at this time to warrant changing the standard
recommendations.