Why the Long NPI – BCBSTX?
[By Darrell Pruitt; DDS]
More than a year ago, Dr. Robert Ahlstrom, an ADA [American Dental Association] and NHII (National Healthcare Information Infrastructure) task force member, told attendees to the ADA’s 3rd International Evidence-Based Dentistry Conference that the NPI number is
“Critical to the future of dentistry.”
But, to this day, he refuses to reveal why. Even though I have learned that he is a very shy man on the Internet; on that Sunday in May in ADA Headquarters, he confidently added,
“It is only voluntary unless you want to get paid.”
His case-closed proclamation shut down discussion cold in a Soviet manner. Did I mention that this occurred at an “Evidence-Based Dentistry” conference? Soviet East Germany was also called the German Democratic Republic.
NPI Harmful to Dentists and Patients
There is nothing evidence-based or otherwise about the NPI number – that benefits anyone but healthcare stakeholders. In fact, the number actually harms both dentists and patients. Like Ahlstrom, the irreversible NPI number is simply un-American. However, the NPI means profit for sleazy dental insurance companies like BCBS of Texas – especially when dentists’ reimbursements for work done long ago are delayed by NPI-NPPES screw-ups. Some physicians’ payments have been delayed for a year or more because of NPPES crosswalk difficulties. Who needs that?
Veteran’s Example Scenario
A new patient called my office this week wanting an appointment to start a crown. We don’t normally block off two and one-half hours for a patient on the first visit, but the Veteran told my office manager that before he was recently discharged, they did a root canal, post build-up and temporary on a tooth that still needs a crown. I like to think other dentists would also risk big holes in their schedules for Veterans. We owe them at least that much.
BCBSTX Dental Insurance
When he showed up with his BCBSTX dental insurance information, my office manager had to tell him that even though his boss was promised by the BCBSTX sales representative that the dental benefits package he bought for his employees was good anywhere, it cannot be used in my office because I do not have an NPI number. I am licensed to practice dentistry in the state of Texas, but that is not enough for BCBSTX. Capricious qualifications are certainly their choice if they prefer to do business that way in Texas, but why does BCBSTX leave it to my office manager to inform their clients about their deception? If a client who pays premiums to BCBSTX likes a dentist who does not have an NPI number, those premiums are pure profit for BCBSTX. It is easy to understand that the more obstacles BCBSTX can put between their clients and obligations to cover their dental bills, the bigger are the bonuses for executives. What’s more, BCBSTX’s leaders’ lousy work ethic permeates the entire dental insurance industry. Compared to BCBSTX executives, AIG executives who kept bonus money should be honored as national heroes.
BCBSTX Rude to Everyone
As the Veteran who almost became my patient works to fit him-self back into society, perhaps the next opportunity he has to break away from work for a few hours, he will be lucky enough to come across a dentist who has an NPI number. If things go well, BCBSTX will not have wasted a Veteran’s time twice – and wrecked a dentist’s schedule – for what? BCBSTX has nothing against Veterans in particular, they are rude to everyone. Since nobody from the company can be held personally accountable, tyranny is as natural as Ponzi schemes.
Attention Texas Employers:
I wish deceptive business practices which insurance companies use to cheat their clients were against the law in Texas. Attention Texas employers; as a dentist who has witnessed harm from BCBSTX, I warn you not to waste money on their dental plan. BCBSTX’s sales reps cannot be trusted to tell the truth and will aggravate your employees as well as neighborhood dentists.
Assessment
If BCBSTX gets away with this dishonesty, what other senseless, but profit-enhancing hoops will they demand next year? How many more dentists and patients can an Attorney General allow them to cheat before speaking up? Come out and fight for your honor, BCBSTX … or not. I bring more than your best attorney can handle and I am waiting.
Conclusion
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Filed under: "Doctors Only", Career Development, Health Insurance, Information Technology, Military Medicine, Quality Initiatives, Risk Management | Tagged: ADA, BCBSTX, Blue Cross, Blue Shield, dental benefits, dental insurane, evidence based dentristy, evidence based medicine, Health Insurance, insurance fringe benefits, National Healthcare Information Infrastructure, NPI Number, NPPES, Robert Ahlstrom, Veterans | 22 Comments »
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