While it’s on my mind, there’s another issue that is irking me and I’ve posted about it on this board and also the LBYM and Health Related Finances Board. I don’t know whether this post of mine clarifies this better than my original post appeared to…
I’m pretty sure this program started in response to the drain that Advantage patients with multiple co morbidities place on a practice if compensation is via a fixed fee (Advantage) vs fee for service. In a general sense, this is totally appropriate as primary care is squeezed financially by insurance company reimbursement at the best of times.
My initial question was-is agreeing to be included in this plan going to mean multiple emails and prompts that seem to be necessary for some folk. The answer, BTW is yes it does. In reality, with my recently diagnosed condition of a familial hypercholesterolemia, I actually DO qualify for the program.
Now, this next point is relevant to most everyone who utilises a third party payer. I’d had cause to query some bills a few years ago that I couldn’t fathom and got to speak with the person who coordinated this within the practice and it seems that both dh and I had been enrolled in the plan even though we didn’t actually qualify. Got that stopped BUT, in calling up the practice and speaking with the person who is now the coordinator to make sure I didn’t get an email every day, I mentioned this incident. I don’t think she quite believed me because she checked back through the progress notes and admin stuff and, lo, it seems that a couple of “diagnoses” were added to our medical histories (thus qualifying us for this Chronic Care Management) that we didn’t actually have, haven’t developed since (our real issues are bad enough, TYVM)…and we weren’t aware of.
Hopefully, I’ve explained it well enough that the repercussions of something like this (which with the best will in the world, it’s hard to dismiss as an accidental error) are apparent.