So following this flawed logic???, if the patient and the doc both agreed to try and help him quit smoking would they deny claims for smoking cessation, for the duration of the pre-existing condition clause in the contract??? I gather they will deny meds for that assistance too then.
So now his and your outcomes are certainly going to be negatively impacted by their lack of finacial support in your attempts to help him quit or at least monitor his condition and general health. So, now let's talk about P4P while we're at it too. If we continue on this twisted path could they, would they try to hold his lack of quitting against you in your numbers under a P4P type situation??? So they won't pay for helping him quit, nor will they probably pay for any tests to keep an eye on him, like chest x-rays, spirometry, ECG's all because they are sort of tied to this disorder and Dx code. Meanwhile he may have a small attackable tumor growing in his chest, the beginings of emphazema and the like, which if gotten early could have much better outcomes but now now we'll all wait the duration of this clause in his contract with his employer. All while using his negative outcome data against the treating (can we call not treating because of denies treatment?) doc. Just great.
This just proves my point that carriers don't give a rat's behind about outcomes when they push P4P, seeing how they all swap employer groups back and forth every year anyway. P4P is but another trick to use, to find a way to not pay hard working docs in certainly specialties like PCP's, Cardio, Endo and the like who will have data to pick and choose from to use to their advantage. Does anyone here really think that they didn't do the math on each and every measure they propose before they roll these stupid things out??? The larger groups who "represent" you guys need to get a clue and finally see these SOB's for what they really are.... SOB's; carpet baggers and robber barons, plain and simple.
Question: Was your claim for assisting him with quitting or for some condition tied to his smoking, or was it one of those the issue simply came up in taking his history and so it was on a laundry list of other Dx's with the claim? I would love to have you share all of this with us as it moves thru their system. Did you say which carrier did this to you and your patient? Have you reported it to AG Cuomo or the state insurance dept???
Yes this industry has hit another real low. "You're momma is so low she can crawl under a pregnant ant"
Good Night and Good Luck,
Paul
