Thursday, April 28, 2016

Why I Left the Aetna Panel

In February, I made a decision to terminate my relationship with Aetna, the health insurance company, and also decided to terminate my relationship with the 1199 National Benefit Fund. Some patients have asked me why I did this. The truth is that I'd come to the realization that I was in abusive relationships with these entities, and the only way to deal with being in an abusive relationship is to leave that relationship.

Aetna does pay providers a bit more than some other insurers, but in every other way they demonstrate contempt for the providers who actually do the work for which Aetna takes the profit. Aetna messed up my credentialing twice, first when I initially applied in 2008, then again in 2014 when I changed my tax ID number. These screw-ups meant I wasn't paid for months and that I wasted hours of my time on the phone and writing emails as well as resubmitting claims, in order to resolve the problems. Aetna also denied claims for bogus reasons, such as in one memorable case when they told me my patient's auto insurance might have already paid the claim. The patient didn't own a car. I eventually spoke to someone at Aetna who was as puzzled as I was by this bizarre statement. She resolved the issue, but only after both I and the patient wasted time trying to resolve the unpaid claim.

The last straw for me with Aetna was in early February, when I received a phone call from a third party, "ArroHealth," saying that I needed to turn over case records on four patients. I inquired as to the reason and was told "it's the annual risk assessment."  I'd been credentialed with Aetna for almost 8 years and had never heard of an annual risk assessment. Moreover, all of the cases were closed, so a risk assessment was beside the point. I don't turn over confidential health records without a good reason. I informed "ArroHealth" that the cases were closed, I was no longer in touch with the patients, and their confidentiality waivers for Aetna were now out-of-date. Of course, what many people don't know is that when you sign up for health insurance you sign a statement allowing the insurance company to look at all your health records. Regardless, this is never something I would do without consulting with the patient. I found out later some of my colleagues dealt with this by asking patients to write letters to Aetna or to ArroHealth saying they were refusing the release of their records. But I didn't want to involve former patients at all. Moreover, because of the consulting work I do as an auditor, I know that payors are capable of finding bogus reasons to take back money from providers. I am not giving back one cent of any money paid for work that I have done. I told ArroHealth that I wasn't going to release the records. Within one week I had decided that if I maintained my relationship with Aetna, I would be subject to more of the same, so I faxed them a termination letter.

As for the 1199 National Benefit Fund, which ironically is a plan for health and hospital workers in New York, they processed by tax ID change application by immediately eliminating my old tax ID number, but waiting six weeks to instate my new tax ID number. This meant that I was listed as an "out of network" provider for six weeks. I don't know if this was extreme incompetence or done deliberately, but the end result is that they owe me hundreds of dollars for a patient's incorrectly processed claim. Although I filed an appeal, I have not been paid.

I counsel my patients not to tolerate abuse and disrespect and I would be a poor role model if I allowed myself to continue to be mistreated by these organizations.

Tuesday, April 5, 2016

How Music Helps Your Brain

I was intrigued by this article in Guitar Player, and more so by the TED video that is embedded in the article:

According to the article and video, listening to music stimulates the brain, but playing a musical instrument enhances brain functioning even more. It makes sense--music is both emotional and logical, expressive and structured, mathematical and sensually stimulating. It links the brain's two hemispheres, and the brain's "executive functioning" would be enhanced by the processing of the large amount of linked information. ("Executive functioning" refers to mental processes of ordering, sorting, linking and prioritizing information).

Does music help prevent dementia? The article and video imply that it could. I'm wondering if there's a possibility learning a musical instrument might also help persons with  ADHD, although, as far as I know, there is no research regarding this. (People with ADHD have difficulty with "executive functioning.")

Although music may be especially helpful in improving brain functioning and stimulating the brain's reward centers, any artistic activity can improve focus and involve what psychotherapists are currently calling "mindfulness"--a state of focus that relieves anxiety and stress.

Performing one artistic activity can also stimulate activity in other artistic areas  ("Violon D'Ingres"). My favorite example is William Blake, one of the greatest English poets, who was by trade an illustrator and graphic artist. Although he didn't achieve renown as a visual artist, anyone who reads his poetry  is struck by its vivid imagery, especially in his most famous poem, "The Tiger."

There are multiple benefits to engagement in artistic activities.