HOUSE Calls: Bee Pollen, Insurance Billing
This week we respond to questions about bee pollen and medical billing.
Dear HOUSE Calls,
Does bee pollen help with a common cold? Where can I get it?
Bee pollen is a “nutraceutical,” which means it is not a medication but it can be sold in health food stores and is often promoted and taken for certain health benefits. It contains the pollen that is brushed off the backs of bees, and it may also contain a bit of bee saliva. It is promoted to help with things ranging from alcoholism to allergies – but we don’t know of much in the way of solid clinical data supporting its use.
We have had some patients that have tried bee pollen for allergies without success. The substance does contain some antioxidants and vitamins, similar to what you would get in your diet and from a multi-vitamin. However, there is more risk for impurities and inconsistency in bee pollen.
We have not been in the habit of recommending this product.
Dear HOUSE Calls,
I recently had a physical with my doctor. I expected that it would be covered by my insurance plan, but got a bill for $126. In addition to by annual wellness exam and preventive testing, we discussed my high cholesterol and back arthritis. I asked my doctor why I got stuck with the bill and he mentioned something about modifiers. Can you explain what’s going on here?
This is a tough and complicated question and there are a few things that we should explain.
First off, most doctors don’t work for themselves anymore. Doctors are still responsible for our work and how we bill, but we receive regular training in how to improve the accuracy of our billing so that we are neither over-charging nor undercharging.
Second, your health insurance is primarily a contract between you and your insurance company. Doctors file your bill as a service, which will delay collections by 30-90 days and often results in underpayment.
So back to your question, imagine how much time the doctor spends with a completely healthy person for an annual visit―perhaps 15-20 minutes. Now what if the patient comes in every 3 months for their diabetes, but each December, they want the diabetes visit and their annual wellness visit? That visit will take more time. It does seem reasonable that the doctor and practice should be compensated extra for that time.
If we just bill for a wellness exam or a routine visit, we will be compensated much less than if we bill for both. So doctors can do this by listing both codes and using a ‘modifier’ to let the insurance company know this occurred. But many insurance companies will not cover both services on the same day, and the doctor has no idea what the insurance company will do with this bill.
There are just too many different plans. What doctors like to do if the visit is long and seems to focus more than a bit on non-wellness problems is to describe this situation to the patient, warn them they might get a bill, and offer to take care of both issues on the same visit or have them come back another day. This is surely confusing, and requires good communication on doctors’ part.
HOUSE Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page, and Dr. Adam Zolotor on behalf of YOUR HEALTH™ and the UNC Department of Family Medicine.
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