[Clodfobble]

It costs me time, plus a little bit of ink and paper, and lots of minutes if I use my cell phone rather than the home phone. Saves me nothing, but it's the only way to see the doctors I want to see. It's not actually much time invested at any given moment, it's about the long-haul persistance.

First, we get a superbill from the doctor's office, which will include the diagnosis codes and CPT codes, because these doctors know we will need that information. (A CPT code indicates what procedure was done, like "office visit established patient," "consultation and medication management," etc. These are standardized by the American Medical Association across all practices, as are the diagnosis codes. They are updated periodically, moreso the diagnosis codes than the CPT codes. This can include really significant changes to the medical understanding of a disease; for example, in October 2010 they released a new codebook that among other things split the diagnosis codes for autism from one code, 299.0, into two codes, 299.00 -- autism current or active, and 299.01 -- autism passive or inactive. They acknowledged kids are recovering, without anyone really noticing.)

The superbill will also include pertinent information like the doctor's tax ID, and their NPI (kind of like a medical license ID number.) With this, we fill in a standardized form, being careful NOT to sign box 13, which would allow payment to go to the doctor. Without the signature, the insurance company pays you instead.

Form only takes about 10 minutes, less if you are very familiar with it. Mail it in, and wait 6 weeks. They'll mail a check, or an explanation of benefits telling you why they didn't pay, or didn't pay as much as you think they should have. Call them back, 15-20 minutes total counting on hold and then talking to someone, tell them why they're wrong, wait another 6 weeks. Repeat as necessary.

Best-case scenario, we float the cost of the visit for 6 weeks and then get everything back minus a standard copay, and over the last few years this has happened maybe 30% of the time. Worst-case scenario, they will continue to bungle the claim in a series of different ways, adding new errors each time an old error is corrected, and ultimately take 9 months and countless phone calls to pay you all of the $5,000 they owe you, in tiny increments. Most fall in the middle, where we get the money relatively quickly, but they say that the "standard cost" for the procedure is less than what our doctor charged, and they're only going to reimburse us the standard cost. The big problem is there aren't many CPT codes to validly indicate the doctor spent a whole hour with you, so we're stuck using codes that inherently indicate 15 minutes of time, and the "standard cost" is already considered to be a quarter-hourly rate, not an hourly rate. Regular doctors won't spend an hour with you even if they want to, because they're not going to get paid for more than 15 minutes.