Jacqueline Vance, RNC, CDONA/LTC

Recently, I overheard a business office manager speaking on the phone to a managed care company, which after approving dozens of patients, kept denying payments — without giving a reason, of course. Then after multiple calls, letters, and so forth, the company attempted to renegotiate the final price.

Wait, what?! I guess they figure that at this point, you are so desperate for cash that you’ll take anything. Do you all feel that sometimes we are stuck in a “Twilight Zone”-type episode of “Let’s Make a Deal?”  

Imagine being a primary care physician, still owing about $100,000 in school loans, paying about another 100 grand a year for medical malpractice insurance. You have office staff, a billing department, a brick-and-mortar office, all kinds of overhead, etc.

You see a Medicare patient for an annual physical. You’re a caring doctor and spend 30 minutes with your patient. You bill $125 for the visit. Medicare pays you $20. And we wonder why no one wants to go into geriatrics.

Then, of course, they bill the insurer for us, the younger patient with average insurance. But the insurer pays only a percentage of what the doctor bills. And we complain that the doctor doesn’t spend enough time with us. I need them to keep their doors open, so I live with it. What a world.

Hey, I think we should see if we could get away with it. Let’s go out to eat at a nice restaurant. Let’s order the steak dinner with a salad and a nice glass of wine. We saw the menu, we saw the prices before we ordered. But when the bill comes, let’s see if we can get away with paying only a portion of the bill.

Um, no … and I do NOT look good in orange. Just saying!

Or let’s try and negotiate. Go into a hair salon and see that they charge $130 for a one-process color, cut and style and we play let’s-make-a-deal like a managed care company. “Um, I’ll pay you $100 for that combo,” and see what they say as they laugh you out of the salon.

The only place negotiations and price slashing works is a flea market.  When did medicine and long-term care become a flea market?

Just keeping it Real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, Senior Director of Clinical Innovation and Education for Mission Health Communities, LLC and an APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.