As Molecular Testing Expands, Labs Find Reimbursement Process Becoming a Herculean Task
Apr 22, 2024 | Greg Cima Here.
NEW YORK – While laboratories have long characterized getting reimbursed for services that they provide as being arduous, more recently they contend the process has become akin to one of Hercules' labors.
"We just spend copious amounts of time on the phone," said Suzette Tidmore, revenue cycle director for pathology lab Pathology Consultants of New Mexico. "I actually have one employee who spends 40 hours a week calling insurance companies to tell them to reprocess claims after we've submitted everything." [continues]
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Let me tell you about something that really grinds my gears: the abysmal circus that is the insurance reimbursement process for molecular testing. It’s like watching a sloth run a marathon. You know it's going to be painfully slow, and it makes you wonder why anyone thought this was a good idea in the first place!
Here we have these labs, right? They're on the cutting edge of medical science, using technologies that sound like they come straight out of a sci-fi novel. We're talking about tests that can sniff out diseases from a mile away, tests that could literally save your life by catching something before it catches you. And these labs, they’re not just playing around with colored water and beakers; they’re investing real time, real effort, and real money.
But then, enter the insurance companies. Oh, the insurance companies—imagine a brick wall. Now imagine trying to explain to that brick wall why it should move aside and let you pass because there's a fire behind you. That’s what talking to insurance companies is like. You submit your claims for these lifesaving tests, and what do they do? They scrutinize them like they're trying to find Waldo on a page that’s just a sea of red and white stripes. And when they finally get back to you, six months later, it's to say, "Sorry, we need more proof. This test wasn’t necessary." Not necessary? Tell that to the person whose life could have been saved!
And the audacity! These insurers have turned denial into an art form. It’s like they’re handing out denials like they’re flyers for a lousy pizzeria. "Here, have a denial! You get a denial! Everybody gets a denial!" And if you dare question them, brace yourself for the Herculean task of navigating their bureaucratic labyrinth. It’s a miracle if you don’t turn to stone from frustration!
Let’s not even get started on the payment rates. If it were up to the insurers, they’d probably want to pay in Monopoly money. Labs are getting reimbursed peanuts—peanuts!—for tests that cost a fortune to conduct. Sometimes they end up not getting paid at all, which is like going to a restaurant, eating a luxurious meal, and then telling the chef they should be glad you graced their establishment with your presence.
And through all this, the labs are bending over backwards trying to keep up. They’re hiring armies of billing specialists whose full-time job is to just call these insurance behemoths and beg them to please, pretty please, with a cherry on top, reprocess claims that should’ve been approved in the first blink!
In what universe does this system make sense? How is this efficient? We’re talking about healthcare, people's lives! And yet, we're letting it be run by what feels like a coalition of the world’s most stubborn mules!
The whole thing, it's not just ridiculous, it's infuriating! It's time these insurance companies stop playing games with people's health and start actually doing their job: to facilitate care, not hinder it! This isn’t a game of "deny until they die." It's real life, and these labs are trying to save it. So for heaven’s sake, let them!
