Monday, July 12, 2004

I Got Paid Today!

A momentous occasion has arrived! I got a check from Blue Cross for $149.61 today.

This represents my first successful 3rd party reimbursement. Yippee! Of course, it's not what I charged for my services, but I didn't really expect full payment. That would be just ludicrous in this day and age. This amount breaks down to a $99 payment for a $165 charge for a physical on a healthy 30-something male; and a $50.51 payment for a $155 charge for a level 3 visit for a new patient (maximum allowed amount = $101.02. Where do they come up with these amounts???).

It only took 15-17 days from the time I first submitted the claim until the date they cut the check. Not bad.

This means that I can start submitting all my other pending claims with the reasonable expectation that not all of them will be automatically rejected. This also bodes well for my future income projections since my initial estimates were for an average payment of $78 per visit. According to my Quickbooks program, I have about $3500 in accounts receivable, ie, this is how much money is owed to me. This is with an average of about 3 patients/week over the past 5 months. When and if I ever build up my patient visits to what I hope (10-12 patients a day), then I see myself finally able to make a living from my solo practice.

For now, I look forward to just being able to break even. For that, my estimates call for at least 3 patients/day. I have a long way to go.

FP Boards came and went uneventfully. They gave us 7 hours to answer all the questions. I used 4. I wasn't even the first one to finish. Some stuff was easy, some was hard. Either you knew it, or you didn't. All I can remember now is Lewy Body dementia and Henoch-Schonlein purpura. Or more specifically, I remember wishing I knew more about them.

Over the weekend, while having dim sum in Chinatown with my family and some friends, I got a call from a friend who was sitting in the emergency room with her husband, who was not my patient. He had accidentally severed part of a finger off with a power saw and they were waiting for a callback from a plastic surgeon. She was hoping I knew someone who might be able to respond faster. Unfortunately, I didn't. I still don't know very many specialists in the local area, since I haven't ever had to deal with them or refer to them before. But I'm going to have to.

My first instinct was to call UCLA, since that is where I have a teaching appointment, plus it is one of the premier medical institutions around. The ER nurse connected me to the page operator who said she would page someone. While I was waiting, my wife paged a plastic surgeon she knew. He gave me the name of someone at USC, which is a lot closer than UCLA, but unfortunately no one answered at that number. So USC's page operator said she would page a hand surgeon from their facility. All this took place as we walked through the streets of Chinatown, with my cellphone clinging to its one bar of battery power left. I knew I should have charged it up before, but before that day, nobody ever called me on a Sunday!

In the callback race, the USC hand fellow called me back first (while taking the metro train back home). I explained the sketchy details I knew, and he explained that usually you had up to six hours to reattach a severed digit, depending on how bad the cut was. After some initial reluctance, I ended up convincing him to call my friend on her cellphone so she could talk directly with him. I figured they wouldn't want to just up and leave from one ER to go to USC's ER, but it might make them feel like they had a chance to have everything possible done.

UCLA's surgeon didn't call until after I had gotten home, but he explained that he had been in the middle of surgery and had asked a nurse to try calling me back earlier (but I hadn't gotten any calls from them). I thanked him for calling, and said it had been taken care of already.

We found out later that night, that my friend's husband ended up going to a Kaiser facility, and underwent skin graft surgery, but apparently they were unable to reattach the digit because of the severity of the cut.

While I was very much on the periphery in this case, it reminds me that in the not too distant future, I will probably be in the thick of things, taking care of hospitalized patients and calling the shots. I need to admit and attend at least 6-8 patients and be proctored by a current hospital staff physician in order for me to receive full hospital privileges. So far, I haven't had any, mainly because the local hospital ER doesn't know about me yet. But I plan to drop by and introduce myself and tell them I'm available for inpatients, but not until after summer's over. It may be the last quiet summer I have for a while.

As for now, my cellphone needs recharging...