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How Far Can They be Pushed?
By D. Kellus Pruitt DDS
Command-and-control organizations like BCBSTX find Facebook difficult to control. Even a small nidus of a complaint posted by a client named Mark about poor service can attract a huge bolus of payback by a dentist, and nobody respects anonymous gatekeepers for huge, unresponsive companies like BCBSTX anyway:
https://www.facebook.com/bluecrossblueshieldoftexas
Mark, as a dentist, I’m very familiar with BCBSTX’s inconsiderate behavior in our communities. At least the anonymous moderator invited your feedback. When I sincerely asked her on Wednesday what federal employees are told about BCBSTX’s NPI requirement, she acted as if the absurd policy hadn’t already wasted enough of my time that day when she provided me an irrelevant link to nowhere – just to get rid of me.
Secret Requirement?
I would actually love to treat federal employees who have BCBSTX insurance because they are some of the nicest people I’ve met. But, BCBSTX’s secret requirement that their clients see only dentists with arbitrary NPI identification numbers (not required by law) makes their employment benefit purchased with taxpayer money worthless if they receive treatment in my office. My office has been told that it has become impossible for paper claims to enter BCBSTX’s modern, computerized system without NPI numbers, and nothing humanly possible can be done to correct the unfortunate problem for dentists who choose not to be HIPAA covered entities.
Evasion?
The moderator’s evasion confirms that even though BCBSTX’s federal customers are led to believe that they can use their dental benefits to help pay for treatment at any licensed dentist’s office, they are not being informed of the NPI requirement, and if they pay the dental bill in full for work done by a dentist without an NPI number, BCBXTX pockets the reimbursement. It just cannot be helped. That’s technology. Tough-luck!
BCBSTX executives naturally prefer that my office manager tell their clients about the obscure restrictions of the dental plans they sell. She catches most federal employees before blocking out time in our schedule to treat them, but nevertheless, one got through on Wednesday morning. It wasted my time as well as the federal employee’s.
Congressional Action?
It’s troublesome to know that the government callously encourages such waste of small business owner’s time and money, not to mention the inconvenience to patients. I’m simply fed up with open appointments for uninformed BCBSTX clients. What’s it take to force BCBSTX to take some responsibility in the community and warn their customers about the limitations of their dental policy before they call my office? Congressional action?
Assessment
I do hope the anonymous BCBSTX employee doesn’t choose to delete this post. Since it seems obvious that their windfall profit is a powerful disincentive for BCBSTX to warn their clients about the NPI restriction any time soon, the more federal employees I can ethically warn through BCBSTX Facebook, the fewer open appointments I’ll have, and less taxpayer money will be wasted on silliness.
cc: Senator John Cornyn
Conclusion
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Filed under: Ethics, Health Insurance, Information Technology, Practice Management, Pruitt's Platform | Tagged: Blue Cross, Blue Shield, Challenging Blue Cross Blue Shield of Texas Again, D. Kellus Pruitt DDS, Facebook, HIPAA, NPI Number, NPI requirement, Senator John Cornyn |
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The BCBSTX beat down continues
BCBSTX’s well-deserved public beat down by Mark and me continues on the BCBSTX Facebook.
https://www.facebook.com/bluecrossblueshieldoftexas
I wonder if BCBSTX’s fondness of NPI numbers has anything to do with winning stimulus money as well as federal contracts for the not-for-profit. Yep. I’ve discovered BCBSTX is much more vulnerable now than when I forced them to delay their NPI plans in 2008, and Mark and I haven’t grown weaker:
I say we make our stand here, Mark.
You, I, over 370,000 readers of the Medical Executive-Post and US Senator John Cornyn have ‘em surrounded. BCBSTX missed the opportunity to delete our complaints relatively quietly, and now It’s too late. We’ve attracted witnesses. High-five.
This morning, the Medical Executive-Post featured my description of our struggle against anonymous people: “Challenging the NPI Requirement of Blue Cross Blue Shield of Texas Again.”
Other than BCBSTX’s Public Relations veterans and at least a few readers of the ME-P, not many are aware that this isn’t the first time I’ve used the internet to force the same unresponsive executives to back off of their secret, absurd NPI requirement – but unfortunately, not before several of my satisfied, long-term patients were forced to seek new dentists who have arbitrary NPI numbers that benefit only BCBSTX executives.
Just like in the last few weeks, four years ago, BCBSTX executives left it to me and my staff to ethically warn federal employees of the NPI exclusion – most of the time before appointment times were wasted. Then like now, BCBSTX’s PR team simply found it too awkward to have to explain to intelligent federal employees that the 10-digit identification number that BCBSTX requires does nothing to improve their dental care. It only makes them change to HIPAA covered dentists. So what’s the harm? It has been said that “changing dentists causes fillings.”
Perhaps like you, Mark, I feel that if I don’t stand my ground against unfair business practices now, tyranny is a slippery slope. What will BCBSTX secretly require of me next year to be paid money I earned treating THEIR clients? The Hippocratic Oath obligates providers to serve patients not insurance executives. I’d like to stick with that.
BCBSTX, it’s clear to me that just like in 2008, irresistible transparency with your customers and dentists will force you to back off your NPI plans again in 2012. Give it up. This time, I went over your head. I shared my complaint with my Congressman – like I should have the first damn time. Either inform your clients or remove the NPI requirement, and please do it quickly. You don’t want to be responsible for harming my small business any more than you already have, do you?
D. Kellus Pruitt DDS
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The Cornhuskers
Darrell – The State of Nebraska just dropped BCBS as state health insurance provider.
Blue Cross Blue Shield of Nebraska is challenging the state’s decision to switch insurance companies for state employees to UnitedHealthcare – a decision worth $184 million annually.
http://www.healthcarefinancenews.com/news/nebraska-drops-bcbs-state-health-insurance-provider?topic=05,19
Mary
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Beyond evasion – BCBSTX
[BCBSTX drops their NPI requirement for paper-based dentists]
This week, a BCBSTX employee responded to my complaints on the BCBSTX Facebook – allowing marketplace transparency to successfully force BCBSTX executives to quietly drop their 5 year old NPI requirement for dentists. What does that tell you about the power of social networks? Individual dentists working independently for the welfare of our patients are much more effective than even the entire TDA in stopping insurer malfeasance. All you have to do is speak out against crimes we’ve quietly mumbled about for decades, Doc. But not anonymously.
Here is my reply to the BCBSTX employee.
https://www.facebook.com/bluecrossblueshieldoftexas
I have a complaint and demand to speak to your supervisor.
During 2007, BCBSTX occasionally mailed newsletters to Texas dentists titled “The NPI Times.” Its purpose was to persuade dentists to volunteer for permanent NPI numbers which benefit BCBSTX but not dental patients. The top story of the December issue is titled: “All providers – including non-contracted providers – must share and use their NPI!”
“Keep your patients out of the middle! In January 2008, BCBSTX will move into phase two, the NPI Required phase of our NPI Transition Plan. During this phase, BCBSTX is requiring the BCBSTX provider number and NPI on all claims submitted by every contracted and non-contracted provider who submits claims to BCBSTX.”
If BCBSTX is concerned about keeping my patients “out of the middle,” why did they keep the NPI requirement secret from their federal clients who were led to believe they could see any dentist of their choice? Isn’t that against the law?
Let’s pretend “The NPI Times” was a massive misprint that just happened to favor BCBSTX rather than dental patients. Less than a year ago, a BCBSTX employee told my office manager: “If a paper claim for a federal employee’s dental work arrives without an NPI number, it can’t even be entered into the system.” BCBSTX still doesn’t inform federal clients of the NPI requirement.
And then, when your boss’s back was against the wall on Tuesday, she told you to tell me, “We do accept paper claims without an NPI number and will continue to process the paper claims submitted by your office.”
Dishonesty from anonymous people who cannot be held accountable infuriates me even more than the inestimable harm their deception causes my dental practice.
Not counting the disappointed federal employee with BCBSTX insurance who’s visit to my office last week was a waste of time for both of us, imagine how many more of your clients who wanted me as their dentist we have turned away since 2007 – just to treat YOUR clients fairly. Still, you lie to me anonymously.
I demand your supervisor – not on BCBSTX’s private provider service line, but right here in front of clients Mark and Beverly who will serve as witnesses. I have critical issues concerning ethics in healthcare I’d like to discuss that are important for all Texas dental patients considering discount dentistry.
Don’t take this personally (as if an anonymous person were capable of shame) but I have never respected nameless avatars who work for unresponsive companies. The only reason for BCBSTX’s anonymity policy is to avoid accountability to clients and providers.
We’re waiting, Anonymous. And please, no more meaningless links to CMS sites. We’re beyond evasion.
D. Kellus Pruitt DDS
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Thanks, Sen. Cornyn
Thanks for your help with BCBSTX, Senator Cornyn.
As of last week, BCBS of Texas’ NPI requirement of dentists – which they keep secret from their clients – will no longer profit BCBSTX by providing the insurer an unfair excuse to deny paying their contractual portion of their clients’ dentistry.
In a related matter, today my office finally received reimbursement checks from BCBSTX for dental work completed over 3 years ago and denied because I don’t have an NPI number. Tomorrow, I will forward the reimbursements to federal employees who gave up trying to get their money from BCBSTX and paid us in full – just like unresponsive officials of BCBSTX counted on them doing.
I wonder how much more federal employees’ money BCBSTX has kept over the last four years because of egregious misapplication of the HIPAA Rule. As an American taxpayer who pays BCBSTX’s premiums for federal employees, I think an audit is in order, Senator Cornyn.
D. Kellus Pruitt DDS
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NPI Numbers and HIPAA
While I am not as familiar with the NPI requirement for dentists, I am very familiar with the requirement for HIPAA covered entities. I also cannot comment about BCBSTX as I do not deal with them directly.
My comment though is about the irony of on one hand Dental health is being promoted as important for the overall health of an individual. This (IMHO) means that the dental community is placing their practice on the same level as the medical community. I agree! Dental health is 100% important and is critical to health as a whole.
The irony exists when you promote yourself to equality within the environment but then do not want to meet the same regulatory requirements. Medical providers (with few exceptions) must gain an NPI to do business. That is a law. Why shouldn’t dentists?
HIPAA laws are far from perfect. There are tons of stuff that Congress inserted because they are politicians. But along with that bad stuff there is tons of good. The privacy laws for one are huge and necessary.
I won’t pretend to know the reasons a Dentist or hygienist would not get an NPI. But I cannot see how you can argue on one hand that you are equal in importance, and on the other hand ignore the fundamental law that is in place to protect the individual with regards to and indivuals health and privacy.
Jason Werner
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Welcome Jason,
Feel free to comment or post on the ME-P any time.
Hope Rachel Hetico RN MHA CMP™
[Managing Editor]
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Thanks Jason,
Since I’m not required by law to “volunteer” for an NPI number that does NOTHING to benefit my patients, how can adoption of the arbitrary 10-digit permanent identification number possibly advance medical science?
“It is the first responsibility of every citizen to question authority”
-Benjamin Franklin
Let’s keep this simple: With Benjamin Franklin’s warning in mind, why is it important to you and other authorities that I adopt an NPI number, Jason? Since you admit that you know little about the NPI – and who does – please share your concerns.
I sincerely want to know.
Darrell
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HIMSS Revisits National Patient Identifier
The Healthcare Information and Management Systems Society (HIMSS) is asking Congress to study patient identification issues, hinting at the need for another look at the controversial national patient identifier while not specifically asking that an identifier be part of the study. HIMSS also asked Congress to review and “harmonize” federal and state health information privacy laws.
The request on patient identification was part of the Chicago-based health information technology trade group’s legislative agenda, developed for its 2012 policy summit during Health IT Week in Washington this month. Meanwhile, an update to the HIPAA privacy rule necessitated by more stringent privacy provisions in the American Recovery and Reinvestment of 2009 has remained in bureaucratic limbo since March.
Source: Joseph Conn, Health IT Strategist [9/21/12]
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