Reflex Sympathetic Dystrophy (RSD and CRPS) Reflex Sympathetic Dystrophy (Complex Regional Pain Syndromes Type I) and Causalgia (Complex Regional Pain Syndromes Type II)(RSD and CRPS)


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Old 11-10-2015, 04:33 PM #10
Hopeless Hopeless is offline
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Join Date: Jun 2013
Location: USA
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Hopeless Hopeless is offline
Senior Member
 
Join Date: Jun 2013
Location: USA
Posts: 1,232
10 yr Member
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Many years ago, ..... long before the days of HMO's, back during a time when health insurance meant "hospital coverage" in the USA, patients paid out of their pocket for ALL office visit fees. There was NO coverage for seeing a doctor in his office. Most lab work and imaging services done as an outpatient also fell into the category of no insurance coverage.

I was hospitalized during this period and had health insurance that would cover most of my hospital stay. The charges for the physician attending to my care IN the hospital was also covered but he charged a fee to file any insurance paperwork. I believe it was a $35 fee per admission.

In today's medical arena, most physicians will file any "health" insurance paperwork for free but any additional paperwork is difficult to obtain, such as disability, workman's comp, etc. Those that are willing, are hard to pin down and get it done. Others are only willing to do so for a nominal fee. And others flat out refuse.

When the paperwork is outside the normal course of routine health insurance filing, personally, I have no objection to paying a nominal fee for the service. It does take time and even if delegated to an office worker, the physician has to pay his/her employee.

This has been an interesting thread and has led me to think about medical charting in today's medical arena.

Now that electronic medical records are being required in the USA, how much of one's medical record is really accurate, depicts the truth of a patient's conditions, and how much is being charted in order to get claims paid.

My question relates to "possible" conditions that get charted that may turn out NOT to be accurate. When we go to the physician, we describe our symptoms. From them, the physician may order some tests before making a diagnosis, BUT, .... and here is what I question, in order to get the insurance company to pay for the testing, the physician must provide a diagnosis code. Let me give an example. Maybe the patient has symptoms that could be "gout". The physician orders a blood test, using the gout code, in order to justify the test. Is gout now and forever in your chart as a diagnosis even if it turns out to be something else?

In obtaining my medical records, I noticed that certain check boxes were marked off as being performed by the physician at an office visit and since I was the patient and part of the exam, I know for a fact that they were NOT performed. These check boxes were a requirement to be reimbursed by insurance and just automatically checked as done.

What good are medical records if they are NOT truly reflective of what actually transpired, what your diagnosis is AFTER test results have come back, etc. And now these records are being shared between medical personnel as an "aid" to our care??? How does an erroneous record aid patients? Seems to be that this could turn into a very detrimental situation.

I realize this is a little off topic but it is related so I thought I would put it here in this thread.

I understand the potential benefit of an electronic medical record, but I also see many problems with it. Just my opinion. Would love to hear others views on the topic.
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BioBased (11-10-2015), DejaVu (11-11-2015)
 


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