Guess how much this visit is reimbursed, in this scenario of newly-diagnosed breast cancer:
That’s where my office gets involved. Five or ten faxed pages arrive on my assistant’s desk. She calls the Gynecologist’s office to request additional material, including copies of the mammogram report, the patient’s contact information and insurance data-if the patient is insured.As it happens, like more than 60% of the women I care for, this patient is either uninsured or underinsured by Medi-Cal or BCEDP, the State of California’s breast cancer detection program for low-income women.
The paperwork piles up. Now my assistant must confirm eligibility in addition to scheduling the consultation, creating a chart and retrieving x-rays for me to evaluate. Prior to the visit, I review the chart and create an electronic medical record.
Next, the visit. Your neighbor arrives at my office. I speak with her for about 15 minutes, learning her medical and surgical history, asking about symptoms and risk factors, and answering questions.
I examine her carefully, assessing not only for breast abnormalities, but also for swollen glands in eight regions of the body. A heart and lung exam is done to identify problems that would make her a higher surgical risk, and the neurological, abdominal and musculoskeletal evaluations provide evidence for or against tumor spread.
After my patient is dressed, she asks me to bring her sister and husband in for the discussion of my recommendations. This is often the most time-consuming part of the visit, requiring patience, repetition and reassurance for a frightened patient and her concerned family.
Although our first visit has ended, the work has not. I fill out a form ordering testing to further characterize the abnormality seen on my patient’s mammogram. I’ll pore over a list of codes required by Medi-Cal to identify the visit, choosing the most appropriate ones and hoping they don’t merit automatic rejection of the bill (a frequent occurrence, prompting up to nine months of back-and-forth debate with Medi-Cal). Because the necessary biopsy requires a Radiologist’s assistance, I’ll communicate with him as well as the Pathologist who examines the specimen provided.
All that, for a bargain-basement reimbursement of $59.50.
