Blue Cross Blue Shield Insurance Issues

I hate to blog about insurance companies and approvals but lately I have received a couple of negative reviews based solely on the facet that the patient’s insurance company did not approve their medications or their procedures. I had one patient give me a two star rating because his Tramadol ER was denied by the insurance company. The insurer, BCBS told the patient that it was our fault that the medication was not approved. I am not sure how it can be our fault since we don’t approve anything, nor do we have the power to do so. All we can do is fill out the prior authorization form and hope for the best. If the insurer denies the medication then there isn’t anything we can do to change that. Nonetheless, the patient blamed us for Blue Cross’s denials. The second negative review was a patient that underwent a single Lumbar Epidural injection as requested by the spine surgeon. Again, the insurer was BCBS and they gave us a prior authorization number which means we can move forward. The procedure was done and then after the facet, BCBS decided that they would not pay for the procedure. The patient was not hounded about it but she returned a year later for a follow up and was told that she had a balance for the procedure. She stated that since the insurance company didn’t pay us that we should get nothing. She then stormed out of the office and gave us the bad review because her insurance wouldn’t pay for services rendered. Again, we do not have any power over the insurance company and their payments or approvals. It is out of our control. As for getting paid for services rendered, if a auto shop worked on your car and the insurer decided not to pay the shop then I am pretty sure they would expect you to pay for the services rendered. I am unsure why the patient felt that we should work for free. Ironically, the patient never paid for the services and I still have a bad review. So she ended up getting her injection for free but still is not happy. The last bad review was a patient that I saw once and then one week later gave me a bad review because we were having difficulty getting her epidural injection approved. We did all the appropriate paperwork but it was denied. The patient states that the insurance company told her that it was our fault that it wasn’t approved. Ironic since after the patient called they have the power to approve it if they wanted but instead blamed it on me the doctor who has no authority to approve anything. This patient came into our office after we called her to tell her since she gave us a negative review that we would not see her again. She was yelling in our lobby with patients there amazed that we would not get her procedure done even after she gave us a one star rating. Again, she had BCBS. The common theme is BCBS being each of these patient’s insurer. BCBS now is the main Affordable Healthcare Act insurer and in keeping costs low, they use a third party vendor to approve everything. Thus, BCBS doesn’t approve anything anymore. When the patient calls BCBS they always tell the patient that it is never the insurers fault and that it is everyone else’s fault that something didn’t get done. The third party vendor has specific guidelines that must be followed for low end BCBS insurance plans and generally we have found that they are very difficult to work with. Many of my cohorts no longer accept the Blue Select or Blue Options type plans simply because of how difficult it is to work with them. The higher end BCBS plans such as Federal Blue and most state plans are still reasonable plans. Nonetheless, I want all the people out there to realize that we doctors do not have any power over your insurance companies and we have no power to get things approved. The insurer may tell you that it is our fault but how can it be our fault when they are the one’s who approve things. It is disingenuous for the insurer to tell you that all the doctor has to do is fill out this form or do a peer to peer review when the reality is that they aren’t going to approve it anyway. They are simply making more hoops to jump through in an attempt to blame others for their poor service. So I have three bad reviews with one or two stars from people that I only saw once and each of them thought I did a good job and actually say that in their review but gave me the poor rating because their insurance stinks and they are using me as the scapegoat. I wouldn’t care but people nowadays are taking reviews seriously and for every one star review you get it take four 5’s to get you back to a “b” rating. The last person said to me that she didn’t give me a bad review but she gave my office the bad review. She didn’t give me a five and then complain of my staff. The one star she gave me alters my score since obviously the rating is not of my office but me and thus the one star is under my name and not my staff. It is like giving a student an “F” rating but telling them that they did a great job. an “F” is still an “F”.

PRP and Stem Cells for injections

In the past I have discussed PRP or plasma rich protein injections. Studies are very few that show that these injections actually help long term. The only studies reveal that PRP does help with tendonitis, specifically around the elbow. A lot of patients of mine think that PRP injections are new. They are not. PRP […]

The way the Military treats PTSD

PTSD or post traumatic stress disorder is a anxiety disorder associated with some type of stressor. The stressor can be anything from abuse to near murder situations. Obviously, the military deals with PTSD in its soldiers on a regular basis. I often work on military individuals and they have been using a old technique in […]

Spinal Stenosis and pain

One of the most common issues that people have to deal with is what is termed spinal stenosis. The term stenosis generally refers to “a narrowing” and can be applied to numerous locations of the body. In the issue of spinal stenosis, there is a narrowing of the spinal canal. The spinal canal extends from […]

Medical Advertising

I often recall PT Barnum’s famous saying about a sucker being born every minute or about the refrigerator salesman who could sell ice to Eskimos. The really is that a lot of people are quite gullible when it comes to advertising. If they weren’t thin advertising wouldn’t exist. I bring this up because of a […]

Vagueness in current diagnoses

First, I apologize for not writing a new blog for quite some time. I have been extremely busy lately. Secondly, I wish to bring up the simplification of medicine that is occurring with the dumbing down of education. It appears that schools are trying to compartmentalize medical problems into simple algorithms. This simplification extends to […]

The realities of opiate pain killers

This article was written by author Laura Tedesco on December 3, 2014 Prescription Painkillers Have Tripled CDC Report: Fatal Overdoses From Prescription Painkillers Have Tripled Has our nation’s reliance on prescription painkillers gotten out of hand? The epidemic of opioid overdoses is continuing to take its deadly toll on Americans: The rate of deaths involving […]

Drug addiction and psychology

Recently, I have been involved in addiction medicine. I initially got into that field due to having patients who were being discharged due to signs of addiction. Lately, I’ve been seeing people who never were my pain management patients and I have learned a lot from them. First, I realize that the majority of them […]

Catch 22

Recently, A New York Physician by the name of Dr. Stan Li was convicted of two counts of manslauter for prescribing painkillers to patients in New York. The article can be read here – The Doctor was accused of prescribing to addicts and one of the addicts murdered four people in a hold up […]

My Opinion On THC

What’s THC? Well that’s the ingredient in Marijuana. A lot has occurred in the past 10 years with the rise of the baby boomer population coming to terms with there age. They represent a group that doesn’t like that they are aging and want to bring their “hippy” values to the mainstream. The question is […]

The pains of pain management

Had a pleasant female patient today that was referred to me by her son. The interesting thing was that I had discharged her son from my practice a month ago for getting prescriptions from another physician. For those who are unaware, in pain medicine, we have contracts with patients that they can only get their […]

An Enlightened Moment

I really try to pride myself on being a caring and compationate guy. Thus, I was very susprised the other day when a patient told me that I treated him poorly. I appologized for anything that I might had done but he felt that I didn’t take his pain seriously enough. Those who know me […]

Pain Medicine and the Modern Society

Recently, in the state of Florida, the laws changed as to the usage of pain medication. These changes greatly altered how most legitimate pain physicians operate. Prior to 2010, we generally only were involved in difficult medication management cases and most of our time was involved in procedures. With the law changes, the state has […]

Pain Masking Devices

When dealing with chronic pain situations, we as pain medicine physicians often get to a point where nothing appears to be working to resolve their pain. The patient either has escalated upwards on their oral pain medicine or the oral pain medications haven’t worked. Obviously, devices like spinal cord stimulation would also be considered a […]

Upcoming issues in healthcare

A lot has been discussed in the media recently about the upcoming changes to the healthcare system. Obviously, none of know for sure what to expect but we in the healthcare field have been told to expect some changes. One of the changes to expect is the exchange system. It is a rumor that most […]

Misunderstood Pain

Pain is a subjective experience. Those without pain cannot understand what it is like to live in constant pain and suffering. We live in a society that values youth and vitality but when people are suffering, it seems that the system wants to turn their back on them. I regularly see patients that have surgery […]

Addiction versus tolerance

I am often asked by patients whether or not they are addicted to their pain medications. I guess a good place to start is to define addiction. Addiction is a compulsive and repetitive action that is harmful to the individual. This implies that you repetitively repeat an action even though you realize it affects are […]

The End Of Private Practice

Times are a changing. With the increasing government control of healthcare and the increasing power of lobbies change is already underway. This involves not just obamacare, this has been going on for the past five years or so. Currently, about half of all healthcare insurance is via the government and their programs, Medicare, Medicaid, and […]

Chronic pain and chronic pain medications

Pain is a very subjective thing. What one person feels is a 10 over 10 another person might rate as a 1 over 10. For example, a navy seal might consider a broken bone not too bad while many people might rate it as severe. There is no quantitative test to determine pain and for […]

Migraine’s – Often Misdiagnosed

I am not sure but I think 80% of everyone out there has migraine’s. Often, they are told this by their primary doctor and the patient takes this diagnosis to heart. As a pain management doctor I get very annoyed when people are given a diagnosis without a proper work up. It would be as […]

Fibromyalgia – Does everyone have it?

There are several diagnoses that are troubling to me as a pain medicine physician. These are RLS, Migraines, Chronic Fatique Syndrome and Fibromyalgia. I find these troubling because many doctors rapidily diagnose people with these issues and then the patient takes that diagnosis to heart. Also troubling is that these issues are what I call […]

February Newsletter

This month’s topic is Sciatica.   What is Sciatica? We as physicians generally don’t use this term since it is vague. People generally don’t have complete damage or compression of the entire sciatic nerve. Generally people have compression of one of the many nerves that comprise the sciatica nerve. The sciatic nerve has branches form […]

December Newsletter – Sacroplasty

A fairly common problem, especially for women, is sacroilitis or sacroiliac joint syndrome. This is pain that arises from the sacroiliac joint (SIJ). The SIJ is the joint between the pelvis and the sacrum. It is commonly those little dimple area that people see on their backside. These joints generally fuse early in life and […]

October Newsletter

October Newsletter A recent study by the Chinese reveals that the usage of Methylene Blue, which is a common dye, when injected into the intervertebral discs may result in significant and permanent reduction of low back pain. The exact method of how this interaction occurs is unknown but the results reveal a 50% reduction in […]

The Artificial Disc

It wasn’t long ago when the artificial disc was considered the cure-all to back problems. The studies that were done in Europe showed success rates that were very impressive. 90% cure rates or so they say. It has been over five years since the artificial disc was approved for usage in the U.S.A. and the […]

Intradiscal Injections

Discogenic low back pain is a major concern for most people. It is the most common cause of low back pain (LBP). Amazingly, until the late 1980’s the discs were thought to not have sensation and thus could not cause pain. We learned that the outer surface is very well innervated and yes definitely can […]

Sacroiliac Joint Pain

Sacroiliac joint pain or SIJ pain is a common disorder that is seen in females much more than males. The SIJ is comprised of the surface between the sacrum and the iliac bones. The two iliac bones comprise the pelvis. The joint is essentially non-mobile in the vast majority of patients and although some believe […]

Discogenic Low Back Pain

Believe it or not, up until the late 1980’s, it was thought that the discs themselves didn’t cause pain. It was known that a herniated disc could press on a nerve and cause pain but it was assumed that the disc didn’t have any innervation and thus couldn’t cause pain in and of itself. Studies […]

Spine Surgery Success Rates

Many spinal surgeries offer some kind of success rate but do you the patient really understand what is meant by “success”? Obviously success means that you had a positive outcome, but to what degree. Usually conventional spinal surgeries offer a good to excellent outcome in 50 to70% of patients. Usually, but not always, good to […]

Low Back Pain

Low Back Pain or LBP is probably the most common complaint in our society. Some say that over 50% of all people will have some degree of severe LBP at some point in their lives. Most of these cases resolve on their own but a small group of around 5 to 10% develop chronic pain […]

Welcome To Emerald Coast Pain Blog

Welcome to the emerald coast pain blog. We’re just starting this up but let’s see what happens.