FIGHTING WINDMILLS

FIGHTING WINDMILLS

Ed Roman, CP, LP

6/1/2002

Hello All: Yesterday I received an EOMB from an insurance company. This is for a patient I provided service to about six weeks ago. I provided the service after being called by the worker's compensation carrier who requested quotes for this service and then, two days later, authorized and forwarded billing instructions and patient information to me. Prior to receiving this information I had no knowledge of the MD or the patient. The EOMB stated that one code's fee was reduced by $201.44 because the allowance in this review are based on the INGENIX database which are considered reasonable and customary in your geographic region. If you disagree with the adjustment, you may contact XXX, Inc. at the address shown below or your worker's compensation department.

Based upon the above, I have decided to try a couple of experiments around my small region. This morning, I went to my customary gas station where I usually purchase 10-12 gallons of gas per day. I noticed that the price has increased from yesterday by $.17/gallon. I filled up and then told the attendant, Bubba, (who I have gotten to know for the past year), that the price increase is excessive and I will only pay the usual and customary gas price based upon my IRS required car expense report I keep with my truck. Bubba then stated that I would pay the pump price or !. he will rearrange my dental work or 2. the police will be called and I will be arrested for theft. I paid the price on the pump.

I then went to my office to pay some bills, looked at my new premium notice from State Farm Insurance for my boat which showed a $5.00 increase from last year. I called my agent and stated that they have been insuring my same boat since 1989 and I wanted to pay what I was used to. I was told pay the bill in full or have no coverage.

I then looked at a bill for the Illinois Department of Revenue for some taxes. I then remembered that the Illinois Department of Public Aid has authorized (and the patients were provided with) 7 prosthesis which have not been paid for yet. (Due to $ problems in Illinois, IDPA is stating that they will pay the invoice after 107 days after it is entered into their system. They do not say how long it takes to get my invoice entered into their system). I then had a great idea. I owe some taxes in Illinois and Illinois owes me lots of money, so why don't I just issue Illinois a credit for what I owe them and reduce the amount Illinois owes me. According to the governor's office, I need to pay my taxes or they will seize my assets. So I wrote a check to cover my taxes.

Now can some one tell me, in terms even I understand, how did O and P became everyone's whipping boy? Why does every third party feel we can loan their client (the patient) money to cover their client's expenses? And why we are all so willing to accept as payment in full, what a third party tells us we should be paid?

Thanks, now I feel better. I think I will stop at Sears and try my new price lowering strategy whith them.
Ed Roman, CP, Licensed Prosthetist (IL), Licensed Orthotist (IL) {Sorry, but in Illinois, we forgot to grant ourselves the privilige of using LP and LO in our licensing bill)