The Headache and Pain Center is certainly living up to it's name this week for a local health plan employee thanks to a breakdown in relations that has lead to bitterness, frustration and outright disdain for the pain management practice.
The irony was not lost on Delia Ruiz, provider representative for Bravo Health Care as numerous attempts to assist the medical office employees with supposed prior authorization entanglements led nowhere. "I have always had at least a decent relationship with those people, but lately everyone over there are acting like total jerks," Ruiz said.
"Despite my best efforts, the girls working in the billing department just don't get it. How many times do I have to tell them that we cannot approve services without obtaining Forms 838, 993 and S119 along with a list of CPT codes involved as a result of the initial diagnosis first?" Ruiz asked rhetorically. "Are they stupid? We already went over this crap a million times. It's not my fault if their brains don't function normally."
Signs that trouble was brewing have been building for weeks as Ruiz' working relationship with office personnel has deteriorated thanks to key staff turnover at the local pain center. "Once I called over there to see how things were going and I was told that Debbie left to go work for another doctor," Ruiz remembers. "I tried to set up a meeting with her replacement only to be told that the Headache and Pain Center wasn't even a provider with our plan. They've been contracted for six years! I have to say that Debbie was probably smart for leaving that circus, but she was the only one who was ever seriously committed to our processes."
The situation has left Ruiz with little recourse. "I'm going to have to fight to train all these barely educated knuckle-draggers all over again even though most have already attended our provider training at least twice already. Without Debbie to keep everyone in line, it's like I was never there in the first place," Ruiz fumed. "I found out that her replacement is like, the doctor's brother in-law or something so right off the bat you know that I'm totally screwed. Everyone knows that once family members get involved in the day to day operations of a medical practice, you can just toss any hope of compliance out the window. This sucks."
Ruiz grudgingly concedes that since the Headache and Pain Center is the only pain management provider in the area, that she'll have little choice but to deal with the situation. "I suppose I'll have to just soldier on somehow, but it won't happen without taking its toll on me physically," Ruiz said with an exasperated look. "As a matter of fact, I have an appointment with my family physician this afternoon and I'm going to demand a handful of dihydromorphinone or at the very least a few hits of Percocet. It's the only way I'm going to make it through the next few days. With my luck though, I'll just bet he's going to refer me over to the Headache and Pain Center for treatment."
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