
Welcome to DR. STU'S BLOG. Along with my podcast at www.drstuspodcast.com it is here that I post my thoughts on a variety of topics on the birthing world. Advocacy for true informed consent and respect for individual autonomy are the basis for the musings you will read here. I hope you enjoy while you learn and I encourage you to comment. Please check out www.birthinginstincts.com for information on home birthing with an obstetrician and my latest news and updates.
Friday, January 22, 2010
Could not make this stuff up!
OK, so my office manager today tells me that Triwest (Tricare), the health insurer for the U.S. Military, has denied me payment for assisting Dr. Lara on a c/section. They also denied our appeal. Their reason: Triwest has decided they will no longer pay for an assistant at c/section. Explaining to them that an assistant at a c/section is the standard of care, medically necessary and mandated by the non-teaching hospital I work at fell on deaf ears. They have done some absurd things in the past but this was a new twist. I called, myself, and spoke to a customer service representative. Well, as you guessed that was a waste of time. He said the policy was decided by their medical director. I asked for his phone number or e-mail but was told they can only be contacted by writing a letter via regular mail. We sent one but does anybody think I will ever get an answer let alone be reimbursed for my work? I was also told that I was not allowed to bill the patient. I guess we are expected to come in at any hour of the day, give of our skill and time, accept liability and do it for free. To not help would only cause difficulties for the attending obstetrician and the patient. So we are now placed over another barrel, not of our choosing, with no recourse because it is the government. Am feeling abused and helpless....again. Hate that feeling. Ahhh, medicine....what a great profession.
So sorry to hear it! Man you just can't win for losing lately. I'm surprised though, I'm down in the San Diego area and recently had a homebirth with a CNM that was approved by Triwest. Still waiting on reimbursement but my midwife has worked with tricare a number of times (which is part of why we chose her) and they pay fairly quickly.
ReplyDeleteI do hope they sort it out, but realistically it sounds like you're high and dry. Just not right. :(
Wow... I'm just speechless over this one. Really? No assistant? I guess it's just a matter of time before hospital policy changes huh? Our hospital's policy specifically states that an OB MUST have an assistant prior to first cut unless it's an emergency. I know because we've had some issues with the policy.
ReplyDeleteWhat kind of liability does this open up to the scrub/OR tech? Does this put the OR tech in the position of actually "assisting", despite having a medical license? What if something goes wrong? I know in our hospital, if an assist isn't there and it's a true emergency, our charge nurse is required to assist.
I'm just dumbfounded over this.
Oops... obviously that statement above should have read "...despite NOT having a medical license?"
ReplyDeleteIt is truly the theatre of the absurd, isn't it? I have been writing about these sort of things for nearly 2 decades. You would think nothing could still surprise me and, yet, here we are again. The bottom line is they just do not care and there is no way to hold them accountable. They know we are bound to do the work anyway. We still have an oath to uphold and advocate for patients. Doctors have too long been foolish and kindhearted and will contiunue to do the right thing until we all quit or become assembly line employees working a shift, unionize and stop caring.
ReplyDeleteAnd they complained about the mortgage brokers!! The real criminals are right under our noses.
ReplyDeleteThat is simply insane.
ReplyDelete