Coos Bay Dermatologist Strikes Out on Her Own, Abandons Billing Codes
December 15, 2011 – In July, Dr. Kathleen Brown decided to leave the Coos Bay clinic where she’d been practicing since 1997 and open her own dermatology practice. It’s not uncommon for doctors to strike out on their own, but Brown’s decision had a twist: she decided to eschew the use of CPT codes, a set of medical billing codes required by the American Medical Association for reimbursement by insurers.
Brown sees a mix of insured and uninsured patients, and she now sees herself as working for the patient -- not insurance companies and not the government. “I think something pretty much everyone agrees on is that the way we pay for healthcare is broken,” she said.
More controversial is Brown’s response to the problem – specifically her decision not to use the billing codes. Just determining the right codes ate into her evenings and weekends, she said, and placed unwelcome restrictions on her practice. “In a sense, insurance companies set the price,” Brown said. “They just set the price a little bit higher or a lot higher.”
When she left to start her practice, Brown told The Lund Report, her patients received phone calls from representatives at Regence BlueCross BlueShield and ODS telling them not to see her, and ODS counsel sent a letter to her office threatening to report her to the Oregon Medical Board, but the board stood by her decision to run her practice as she does. A spokesperson for the board couldn’t comment on whether such a complaint was made, since only actions taken by the board are public information.
Regence spokesperson Scott Burton declined to comment for this story. Earlier this year, using part of a $56 million payout to its holding company, Regence started a subsidiary company, Sprig Health, which functions as an online portal to connect patients with providers who will see them without insurance, lists prices and allows patients to pay with a credit card.
Jonathan Nicholas, ODS’ vice president of corporate branding and communication, said he was unaware of any ODS employees having contacted Brown’s patients, and added that ODS is unable to reimburse patients for services if their providers don’t submit billing codes.
CPT billing codes are mandatory, Nicholas said. “You can’t be half in and half out. If you want to bill insurance companies, you have to have a code.”
Thus far, Brown’s practice is doing well financially. “I haven’t done a formal profit and loss, but we are financially viable and able to take a check,” adding that she’s paid off her school debt, and that if that weren’t the case, her business would not be as viable.
Brown said many healthcare discussions center on the high costs incurred by uninsured patients, but she doesn’t think they’re the sole driver of spiraling costs.
She believes more physicians will find alternative ways of delivering healthcare without dealing with insurance companies. “I didn’t anticipate that insurance companies would still try to control the way I practice.”