New Year, Big Changes Part 3

Gods I hope I can get this into one last post.  I tend to elaborate too much or else I assume people know/understand things they couldn’t possibly, unless they were there.  so.

I incorporated, I got a Tax ID, I got a group NPI (a must to take insurance payment), a bank account, and I researched what all was involved in getting credentialed with Medicare and Medicaid (or in my state’s case, AHCCCS).  But.  I drug my feet HARD on actually starting it.  Because that, in my mind, was the final step – the step that meant I was really going to do this.  Which meant I was really going to quit my not cushy but mostly predictable job.  Which is a rather frightening thought.

I suppose I should say what I wanted to do for a business.  I never wanted to compete with the other office, that was never my intention.  What I wanted to do was make it easier for those with debilitating chronic illnesses, those without their own vehicles and dependent on medical taxi services, those who were too sick to go to the office, to see a medical provider.  I wanted to do HOUSE CALLS.  I did a lot of research on the idea and it really seems like an idea whose time has come once again.

Mr. TinFoil was initally EXTREMELY against the idea of starting our own business.  He asked one of his medical directors for advice – without consulting me.  The medical director, who just the week before had told Mr. TF he was making so much money working for Mr. TF’s company that he was only seeing patients in his *own* practice 2 days per week, said it was a very bad idea and “the only way to make any money at this is to save up to buy your own business and have the waiting room full all the time.”  Hmmm…not a very reliable source in my opinion, given the apparent hypocrisy and inconsistency between the two statements.

But then he asked some of his coworkers what they thought of it, and all were universally enthusiastic about it.  One of the NP’s who works for his company even asked him to keep her in mind if I expand enough to hire someone else.  Which I thought was a fairly ringing endorsement.

I had already done WEEKS worth of research on Medicare pricing structures for our area so our superbill could be updated (and corrected).  It was simple enough to add in the pricing for home visits to my research.  I kept the results of my research in a separate folder on my computer and also in hard copy to make sure I had access to it even in the event of a computer failure.  Thank the Gods I did, because with the change in ownership and the loss of my job, it was already done and easy enough to put to use.

So after I got canned, I started the processes for getting credentialed.  UGH.  It took me 2.5 days to wade through the Medicare applications, IRS forms, etc I needed for myself and for the business.  And I mean 10 -12 hour days, not 2 hours here and there.  I suppose it’s faster if you’ve done it before though.  Then I began the process for getting credentialed with the insurance companies.  Which has been a problem, because if you don’t have a Medicare number you basically can’t get credentialed with the insurances.  Much of that work time has been wasted, and will have to be done all over again when I get my Medicare number.

This week I will begin marketing my business in earnest.  I live in a retirement state, there are huge numbers of people that this will appeal to!



3 responses

  1. We really need doctors to make house calls. The way that the medical system is set up is that people will use an ambulance to go to the hospital because it’s so much more convenient and easier than trying to even get in a doctors appointment since scheduling is two months away and you can’t afford to pay to get there even though there is supposed to be ADA transportation. In Vermont Medicaid means every doctor appointment you have free transportation to and from. You probably will be in the waiting room a lot longer but in Portland Oregon my friend tells me they don’t have anything like that although they do get a discounted bus pass so when people need to see the doctor they call an ambulance. Medicaid pays all of that money for ambulances but doesn’t pay to just provide transportation to and from appointments? The system is set up in such a way that when you are living on $700 SSI with subsidized housing which means that you can’t get food stamps – you end up calling an ambulance to get to your doctor appointment. (If your doctor works out of the hospital.) That’s completely insane! But these are the things people are forced to do. With a severe chronic illness nobody could take the bus and the transfers to go to their doctor appointment! And they can’t afford a taxi. What good is having health insurance if you can’t get to the doctor? Meanwhile in New York State most doctor offices have a sign (pharmacy is as well) stating that they don’t take Medicaid. I asked a doctor about it, Medicaid doesn’t pay . They just don’t pay. You can file and file and file – they don’t pay. Because of this if you have Medicaid in New York State you can’t go to any providers.

    Then people wonder why people buy the drugs off the street. If the pharmacy will not sell you your heart medication because of your insurance and somebody with other insurance gets it for a two dollar co-pay and turns around and sells it for good profit – Medicaid caused that in New York.

    So many people blame sick and poor people for “playing system” without understanding that the system is totally broken.

    House visits for people with chronic fatigue syndrome, fibromyalgia , other metabolic illnesses makes so much sense. I do almost all of my doctor appointments by phone but I do have to see my prescriber four times a year. Because one nurse practitioner who did not have any doctor that she worked under and decided I was “drug seeking” because I was expecting to be kept on the same amount of medication that the physician at the clinic and the hospital decided I should have I am banned from every practice using the same billing management company – the people who own the practice. That is every single practice within 45 minutes. Also none of them know anything about MCS . My position in New York tried contacting that clinic because he said it was malpractice to just take away opiates without any weaning and also it’s malpractice to tell someone to go to the ER to get their medication – that’s what the nurse practitioner said . She told the patient who is been on narcotics every day for several years that the specialist, her former position she worked under, the hospital and her doctor in New York all agreed that she needed that she was just stopping the medication cold turkey and if patient needed anything for pain or withdrawal to go to the ER.

    Then at the ER you will just get yelled at because you are a GOMER, get out of my ER. And the nurses are incredibly rude to encourage you to never return. But doctors are constantly telling patients who are trying to get an appointment that day or the next one to go to the ER instead. One thing that rural America doesn’t have enough of are urgent care stations. You probably are not going to die but something is really wrong. Your PCP can’t see you for seven weeks unless there is a cancellation and the ER is going to be really mean to you.

    So I have to go two hours to see my PCP – who I love – and then two hours back – luckily her office is really fragrance free so with my mask I usually do okay , and then it can take several days to recover from going to the doctor.

    When doctors complain of people abusing the system I find that really strange because most of the doctors I have talked to are really really stressed out because the billing management company that owns them has decided that the neurologist only can have five minutes per patient. So now the neurologist is a total jerk to all his clients and they leave. Physicians keep telling me they are not given enough time to actually do anything other than write a prescription . They don’t actually doctor. They don’t use any of the skills they learned. I’ve had them burst into tears, throw crazy temper tantrums that made the student doctor cringe, student doctors tell me about all of the fighting the doctors are doing about me and who gets control , nurses who are getting their masters degree in anything but medicine , they know the system is a total disaster.

    So I think a lot of them actually with envy getting out of the florescent light stress box and visit people at home. The doctors have told me that they don’t have time anymore to argue with insurance companies to get the tests or treatments that are necessary.

    The patients and the doctors and the nurses are all really unhappy with the set up. The only people who seem to think it’s working are the insurance companies . But now they don’t think it’s working because Obamacare has made them take people with pre-existing conditions – which is good – but insurance companies don’t want people to see doctors. So having people who need to see doctors is negatively affecting the insurance companies.

    So really I guess the only happy people with this system are the billing management companies that control everything.

    I really commend you for fighting so much with all of the insane redtape and the doctor eat doctor mentality and just continuing . I sense that you don’t have any other option – not because you couldn’t do something else but because you really are called to do this. And from what I experienced the Gods really reward people who follow their calling. They can’t change all of the obstacles but they can grease the wheels or keep you passionate . And I’m really grateful that they are doing that with you because there is such a need for home visits. I really really support and admire what you are doing. It’s something that they say can’t be done – so the tinfoil hat society wins. 🙂 congratulations because even if it’s really hard you are actually doing it even if it’s not full-time you are doing it. Excellent!

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