When Dr. Kathy Cain began her training as a pediatrician, she focused on acquiring the knowledge she would need to diagnose and treat her young patients. Little did she know at the time that after establishing her practice Topeka Pediatrics in 2001, she would be forced to take a crash course in the business of health insurance.
When vaccine administration codes were created in her home state of Kansas, Dr. Cain immediately noticed she was not being paid by their state-level Blue Cross Blue Shield (BCBS) for the work she was doing. “What it really comes down to is that BCBS of Kansas (BCBSKS) was redefining billing codes so as not to have to pay pediatricians for the administration of vaccines,” explains Cain. “Figuring out how to fix this problem was a journey, to say the least.”
“Many pediatricians, especially those in private practice, go into the field because it is a true calling. I knew I wanted to be a pediatrician from a very young age. I had my own wonderful pediatrician growing up in Topeka, Kansas. He was extremely personable and used humor to make his small patients feel comfortable with his hilarious Donald Duck impressions,” recalls Cain fondly. “I saw what he did for the children in his care, and I thought, ‘I want to be that someday.’ Unfortunately, I did not, nor do most aspiring pediatricians, ever receive any formal education on the business side of things, particularly on how to deal with insurance companies and other payers. The lack of training on these matters can leave us at a disadvantage.”
“Healthcare providers deserve to be paid fairly for what they do, and unfortunately that sometimes means going head-to-head against these corporations for payments they really don’t want to make. Learning to work with insurance companies is essential to your livelihood as an independent physician, so you can keep your practice doors open,” says Cain. “It’s just a fact that good business is good medicine. Sometimes going up against large insurance companies to receive payment for treatment given really feels like a David and Goliath situation. Still, when I saw what was going on in my home state, I knew I had to do something to change a bad policy.”