Help! I'm pulling my hair out!
I'm office manager for a small optometric office. I'm ABO Certified and have worked in the business for 15 years and at my current position for 10. We employ six people including the doctor. I process between $11,000 to $15,000 worth of insurance claims a month (approximately 220 claims) for everything from Medicare, Medicare Advantage to VSP. In addition to this, I send out billing statements, dispense eyewear/contacts, do repair/adjustments, provide monthly financial reports to our accountant, check in lab work, maintain frame inventory, address patient complaints, am at the beck and call of the doctor, and help technicians when they are in a jam. I'm definitely a working manager and try to provide the best possible customer service I can. I bend over backwards to make sure people are satisfied with our products and services and that they always have a positive encounter when visiting our office.
My problem is this: over the course of the past couple of days I have been chewed out by patients for billing procedures that are not necessarily my fault, but have left patients irritated with me nonetheless.
Problem 1
Mr. Jones comes in to discuss his bill from November for a Medicare exam and glasses. The receptionist offers to help, but he refuses to discuss it with her. He wants to speak to "the head guy." He won't even leave his name. Unfortunately, for Mr. Jones, I am at lunch. When I return I am told about this, but because I have no idea who it could be I make no attempt to contact this person. Mr. Jones returns the following day obviously annoyed with me. I ask him into a dispensing room to discuss his issues. He tells me that when he was at our office in November he was told by the receptionist he "was paid in full." However, in his view, this statement wasn't true because we didn't tell him his Medicare charges were going to Medicare and then to his supplement for payment. I have a copy of the statement in our system printed. I review it with the patient. It obviously shows his exam was billed to Medicare. He paid for his glasses and his refraction fee. The exam charge was paid by Medicare and his supplement picked up the remaining 20% copay. He owes our office nothing. So, what's the problem you might ask? We didn't tell him he "may" have to pay something if Medicare or his supplement didn't pick it up. I apologized even though I felt we did nothing wrong. This patient has been on Medicare for the last 10 years. One would naturally assume that this is not the first time he has encountered this nor is it limited to our office. He left satisfied that he "gave me an education" as he informed the receptionist as he left. He promised to be back next year and didn't want a repeat of this past year. Mr. Jones also cops an attitude that I was trying to avoid him and evade answering his questions. I guess I should never leave the office and keep a cot set up in the back to be present 24/7 in the off chance he may come in and be inconsiderate enough not to leave his name.
Problem 2
Mr. Smith has a GDx test and refraction performed at the beginning of 2009. Our office bills him for the GDx (receptionist accidentally charges him half for this test) and the refraction because the patient hasn't been to any other doctor and has not satisfied his deductible. His total bill is $68.08 which he pays and it is applied to his deductible. A month later we receive a check for $37.60 from his supplement which we forward to the patient since his bill has been settled at the time of service. He calls yesterday while doing his taxes adamant that we owe him $68.08. I worked through this "problem" with him. Explained to him his refraction was not a covered service under Medicare and therefore not paid by the supplement either. This took approximately 10 minutes of convincing until he finally relented and agreed to "forgive" the $27.00. This left us with an amount of $41.08 in dispute. I pointed out to him through his own admission he received a check forwarded by us from his supplement for $37.60. After twenty minutes of back and forth on the phone, it finally boiled down to him being angry that we have "owed" him $3.48 for the past year. He stated "that's $3.48 of my money you've had sitting in your account." I'm not even sure if we are legally obligated to cut him a check for this amount. We do accept Medicare assignment, but do not have any agreement with his supplement to write off this amount if they choose to pay $37.60 instead of the whole $41.08, but in the interest of keeping peace we're cutting him a check. Perhaps it is my fault that I missed reimbursement to this patient for $3.48, but I don't feel it is cause to allow him to belittle me or question my integrity. This is the tone he adopted during the call.
I guess my point is I'm tired. I'm tired of not being respected for my expertise or assistance. I'm tired of making a substandard wage (I realize the economy is in the crapper), but even in good years I'm paid diddly. I'm tired of people not understanding their own insurance plans and making it my fault. I'm tired of people using me as a doormat when they're having a bad day or just feel mean. I'm thinking about getting out of the business, but if anyone could give me some pointers in how to handle situations like this I'm all ears.
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Originally Posted by eyeglasses
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