The phrase “Stickin’ it to the Man” essentially means “fight back” or “resist”. For those in the medical healthcare business, the “man” is the insurance company that instead of working with you to help their member (your patient), they seem to work against you (and them) by preventing your claims from processing.
There are many tactics an insurance company will use. Our all-time favorites are:
- “We never got the claim.” (Even though you sent it with a bunch of others at the same time and those got processed)
- “The information provided on the claim is incomplete, missing, or invalid.” (Seriously, make up your minds! Which is it?!)
- “The zip code is not in the correct format.” (And other format related excuses for non-claim related information when claims are sent electronically.)
What is even worse is when they decide to downcode the claim and pay you a lesser amount because they simply felt like it even though – time and time again – you provided everything they needed at the time the claim was submitted.
There are many others, but you already know them.
So, how can you stick it to the man? Let me count the ways:
(1) your provider belongs to an association of some sort (the AMA, NMA, APMA, etc) – use the power of numbers to get many others on board and have the association work on your behalf to represent you against the insurance company directly, and against the goverment (both State and Federal) to control these wrongdoings.
(2) start writing letters of complaint to your Councilman, Senator, and State Representative. Create a template on Microsoft Word that you can use each time, and copy and paste into the letter the rejections (or those things that just don’t make sense) into the body of the letter, along with the claim information which can be extracted from the medical practice management billing and electronic claims processing software program (like VertigaPM) that you are using. Enough people sending these types of letters is bound to get someone to help you.
(3) turn them in to your local TV station. Many TV News stations offer a “Working for You” type of service where their investigative reporting team will go out and investigate corporate wrongdoings. If enough of your fellow Medical Billers and Medical Providers have the same problems, a case can be opened up against them.
Make sure you keep adequate and detailed records, and – as always – make sure you’ve done all you can to keep your billing clean.