today's gonna be uneventful... today's okay..

[kismetRN]

my morning ritual at work (OPD) - open the desktop, log in to HIS, wipe the table, BP cuff and machine (when and while the computer would seem to be in a snail motion), take a peek of Doctor's appointment, and squeeze in a cup of coffee while doing all of the above.

seeing nothing special for today's menu (all pt listed were new, no pt returning for scheduled procedure) i smiled.... this is gonna be SMOOTH.. hum hum hum:D

@9am a teenager pt came, with ILVEN on face..bahhh! this means LASER, i thought.. emla cream applied, laser machine set to desired parameters, health teachings given, blah blah blah.. procedure DONE by the doctor and discharged; went to my desktop to do my notes, DONE in a jiffy,

all is well,,all is well.. hum hum hum

the day went by as usual, mostly getting distractions from pt's asking for lab results esp thru phone conversations.

Half an hour before getting off to work though- i was asked to do patch test for a pt with chronic dermatitis.

I can easily tell she's really not into friendly conversation by her way of staring. Ok so all materials prepared and ready. I ask her if she has the paper and if she went already to cashier (our standard protocol is pt to pay first before any procedure). She replied with a hint of sarcasm "I won't run away for bills". Fine, i thought then proceeded. Health teachings given, then I let her go.

10 minutes later the insurance staff called me to inform that pt's insurance won't cover the test. Okay so I called the pt, informed her that she needs to pay on her next visit when doctor would interpret the reading. I was half way explaining things when she just blew up at me and told me she won't pay a thing for the procedure. She insisted that she should get her result even if its not covered coz it would be a waste since the patches were already put on her back. baahhhhH!! i ended up venting my exasperation to the insurance staff. If worse comes to worst, I would be the one to shoulder the procedure's cost.

[newrnltc]

whoa whoa! I don't feel that you should be responsible for the cost of this test. the insurance staff should have checked with the pts policy if the test is covered or if it requires a prior authorization. If you are talking about the patch test that I am thinking of (needs to be placed in fridge, pt needs to come back for 2 separate readings) -- that test is over $600. Do not let the pt bully you into reading the test. You need to discuss this with your manager/boss/doc supervising you on what is the next step to take. Especially since the doc is the one that will do the reading. Pretty sure you know to check insurance plans before performing procedures from now on. Pt may even be able to work out an agreement with her insurance plan if you can show documented medical necessity for this test: chronic dermatitis affecting quality of life, failed medications, need to identify triggers etc etc...... I am always happy to work with pts on issues but if they are hostile from start to finish as you are describing there is also the collections agency

[kismetRN]

whoa whoa! I don't feel that you should be responsible for the cost of this test. the insurance staff should have checked with the pts policy if the test is covered or if it requires a prior authorization. If you are talking about the patch test that I am thinking of (needs to be placed in fridge, pt needs to come back for 2 separate readings) -- that test is over $600.

@newrnltc - yes, you're right about the patch test (European Series) and the price! fortunately I was saved though - the finance staff settled the issue.

I really am prone to bullying since I'm not good at defending myseLf,, I rarely show if I'm hurt inside.

I am trying to do something about this side of me, and a lot of times I wish I have the gift to speak well.

[T-Bird78]

Nope, you're NOT responsible for the cost of the patch test. The front desk/insurance are responsible for verifying benefits prior to any procedure, but the pt is ultimately responsible for any non-covered charges or procedures. If the pt refuses to pay, then further collection proceedings will take place. If pt does return for patch reading then the front desk can deal with her before further services are rendered. Also, the front desk/insurance staff should have been the ones to call pt regarding the fees, not you. You're the nurse, they're the insurance specialists, let them handle their end. I worked in medical billing for 7 years before I went to nursing school and I still defer any insurance/payment issues to my front desk because I know they know better than I do what's going on.