Welcome to Oz - Ignore that Man Behind the Curtain: Corporate Billing for Anesthesia Services

  • Thomson, Sydney, MD, FASA
| Feb 10, 2020

Sydney-Thomson-MD-FASAI want to share our convoluted journey down the yellow brick road discovering the “Great and Powerful Oz” of Corporate Anesthesia billing.  The story begins……

The “cast”

            - Dorotheos, a patient buffeted by the winds of a cyclone (my husband)

            - Scarecrow, an orthopedic surgeon

            - Tin Man, an anesthesiologist

            - Cowardly Lion, an ASC

            - Glinda the Good, a physician spouse (also an anesthesiologist)

            - The Great and Powerful Oz (see the end)

My husband had surgery at an ASC in early November with TIVA and a Femoral Nerve block administered by a physician anesthesiologist. Dr. Tin Man was technically proficient, though we barely learned his name as he ran from case to case.  A few weeks later, we received paper invoices from the surgeon’s office and the ASC, and EOB’s from our insurer outlining our financial responsibility.  Everything matched.  Just before Christmas my husband receives this text: 

Text pic for CSAOF 2102020

Would you click this link?  Your first name at the top is spelled incorrectly.  You don’t know the sender nor recognize the generic sounding name of the medical group. Surely this must be a dream. You have been warned about phishing scams, so you delete the text.  Three weeks pass and you receive the same text. My husband shared the text with me and realized we had not received an invoice from the anesthesiologist. We did not receive a business card or other contact information for Dr. Tin Man, and no  information regarding anesthesia billing was disclosed on the DOS. My husband did not recall signing anything opting in to receiving text messages from this sender. We checked with our local Munchkins (teenagers) if bill texting was the new norm. The answer was an emphatic “no”,  they would never click that link.

With all the corporate consolidations in our area, I honestly did not know who to contact. I wanted to see how a patient would navigate this system. So, I (Glinda the Good Witch) told my husband (Dorotheos) to follow the yellow brick road to find answers. 

First, he called the Scarecrow’s office. The surgeon had requested the anesthesiologist for the case and should have the best contact number. The surgeon’s office only had a toll-free number, and like the Scarecrow in the movie and books, had no further thoughts on the matter.  My husband called the 866 number and asked for the anesthesiologist by name. He was promptly told they have NO physician names and demanded his account number.  He had no invoice from the anesthesiologist, so no account number. He was asked to provide his name and DOB and was told he was not in their system as a patient. Then the representative said just click on the text (click your Ruby Slippers three times) to get your account number.  Needless to say, he would not click on any links since they would not identify the anesthesiologist as being part of their system.  My husband was frustrated and asked me to intervene.

I called the ASC and identified myself as an anesthesiologist needing to get in touch with the anesthesiologist’s office so I could speak with him—surely, they had the name and contact info of the group that was contracted to provide anesthesia services? Were they afraid, like the Cowardly Lion, to give out this information?  I inquired if texting links to patients was part of their billing process? The office biller said she had never heard of anything like that before!  Definitely no! She instructed me to GOOGLE the anesthesiologist’s name and see if there was an office listed. Google provided three different listings in different nearby cities and the phone numbers were all the main operator lines to the various hospitals. No office, no corporate name, nothing.  

I called the 866 number and insisted on speaking with a customer service manager.  I identified myself as the District Director for the CSA  and that my husband and I were very dissatisfied with this experience. The representative was in a call center in Kansas City. The Great and Wonderful Oz had decreed that texting was Green (like everything in the Emerald City) and the future of billing! It replaced their traditional system which had been used for years successfully. He shared we were not the first to complain and express frustration, but  like the Flying Monkeys they had to follow orders – it was beyond their control.  Finally, he revealed that Dr. Tin Man’s practice was acquired by the Emerald City overseen by The Great and Wonderful Oz.    

My non-medical husband asked how can we expect the public to perceive us as “real doctors” when we have no office (virtual or physical), no identity in the billing process,  and no contact information in case of patient concerns or questions?  He received a postoperative call from the ASC but not the anesthesiologist.  If there had been a problem with his Anesthetic/PNB  nobody would have known how to reach Dr. Tin Man. He found the whole experience cold (heartless), time-consuming and unprofessional.  Imagine what the satisfaction scores will be like now!

The moral of this story is that in the name of efficiencies, the Corporate Business of Anesthesiology is turning us into faceless, nameless “Tin Men” perceived by the public as less than “real” doctors. We need to demand a voice in the design of billing processes that represent our work and provide business cards to patients with local contact information. At this critical time in anesthesiology we need to have the courage and brains to insist on transparency and control of our public persona otherwise we will lose the heart of our physician identity to Oz. 

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