Friday, March 27, 2009

What Are They Thinking, Anyway?

I don’t believe this.

This morning I received a phone call from the plastic surgeon’s office. The surgeon himself is away at the annual American Burn Association convention in San Antonio, Texas, and the call was from his practice manager. Apparently, because the workers’ comp insurer would only authorize paying 70% of his fee instead of the “usual and customary” 80%, he will likely not do the procedure I’m scheduled for a week from this Monday.

Whether they realize it or not, they have put me in a very difficult position.

What kills me is that the fee he charges for this procedure, from what I’ve been told, is in the neighborhood of $4800.00. The fee schedule from the Massachusetts Department of Industrial Accidents (the “DIA”), between harvesting donor tissue and transferring it onto the wound, is approximately $1000.00. And 70% of his fee is approximately $3500.00. So even though he wouldn’t be paid what he is asking (in the neighborhood of $3900-4000.00), there is only a difference of about $500 that his office is fighting over with the workers’ comp people.

To me, that seems pretty ridiculous.

My friend Karen suggested to that the concept of professional courtesy is still alive and well and I should consider approaching that with him. I am willing to do that, but if I’m told flat out that it isn’t an option, I have to pursue other remedies. The most radical is finding another surgeon to do the procedure. Another is to file a complaint with whatever organization handles problems like this. After all, I don’t believe that once he accepted me as a patient under these circumstances he could refuse to do the procedure. And it isn’t like he’d be doing it for free or at a Medicare/Medicaid rate; he would be receiving considerably more than what DIA prescribes.

Just the same, this is something I really don’t need. I don’t want to be put in the position of having to start this process all over again, and if this happens it will put me out even further, in terms of getting back to work.

Let’s hope the ideas put in front of me are successful. Otherwise I could be in a whole lot of trouble.


Elizabeth said...

What a nightmare!

I have no suggestions to offer, but
my prayers for a safe and speedy resolution.

Deege said...

Fellow NH resident here, and I've been following your journey for a while, and do enjoy reading your blog.

This situation has to be so frustrating for you. I'm wondering if this doesn't border on patient abandonment? Haven't they accepted you as a patient by scheduling surgery? It seems to me that they have, and because of that should they decide not to treat you, they must give you 30 days notice, plus refer you to another physician.

Could this be a case where the physician's office staff is more of a liability then an asset?

Have you talked to the WC adjuster about this latest turn of events?

Walt Trachim said...

I am scheduled for surgery on Monday, April 6.

The abandonment issue hadn't occurred to me; of all things to consider this is one that should have jumped out and bit me from the beginning. Thank you for pointing it out.

I also have a call in to the legal department of the Massachusetts Bureau of Industrial Accidents. I expect to be talking with them Monday morning.

As for the staff at his office, my impression is exactly as you describe in that I think they probably cause more problems than they solve. We'll see what happens, though; on one hand I don't want to cause myself more trouble, but on the other, "the clock is ticking", and I don't have a lot of time to play with. So if I have to play hardball, I will....

Thank you for the good words. As much as people seem to enjoy this blog, I think I enjoy writing it as much, if not maybe a trifle more. It's a great outlet.