An Anchorage psychiatrist has had to drop more than 60 elderly patients covered by Medicare because she refuses to use her husband's name in her business and in various databases the government keeps of doctors.
It's a story of bureaucratic stubbornness so weird I had trouble believing it. Now I understand better why many Alaska doctors refuse Medicare patients.
With luck, the attention brought by this column will untangle the problem and Dr. Merijeanne Moore will again get compensated to care for these patients. It has to be simpler than is claimed. There must be an override button on the computers.
But that won't solve the underlying problem: a notoriously difficult, confusing and infuriating bureaucracy.
The story begins in 1999, when Moore married. She had already been practicing for a decade and didn't want to change her professional name, but did add her husband's surname to her own, mostly to simplify international travel. She became Merijeanne Anne Moore Hollingsworth. Not hyphenated.
Her attorney assured her at the time that many doctors keep their professional names even if taking a spouse's name for other purposes.
He was right. For almost 20 years the name issue never arose as she regularly treated more than 600 patients, mostly for medication management of chronic mental illness, and was compensated by all kinds of insurance, including Medicare.
As Medicare reimbursement lagged, many doctors have limited who they see, making it difficult for elders to find care in Alaska. But Moore accepted them. She said she'll be on Medicare herself someday.
She receives $180 for a typical bill paid by Premera Blue Cross Blue Shield of Alaska, where she is in-network, Moore said. For the same service, Medicare pays $42. Her 64 Medicare patients brought her practice a total of $13,000 last year.
In addition, the Medicare paperwork takes much longer. For example, in June, when Moore's lease ran out at her office location on Denali Street, Medicare required a 28-page change-of-address form to move a few blocks to 16th Avenue.
A Medicare representative told her to fill in only the relevant parts of the form, but that was rejected as incomplete. When she filled in the rest, the problem started.
On a line asking for "other names," she disclosed that the Social Security Administration lists both her surnames, Moore and Hollingswoth. Apparently the computer choked on that. Her form was rejected and she was kicked out of Medicare.
A supervisor in Minnesota for the company that manages Alaska Medicare paperwork explained that if she used a hyphenated name, Moore-Hollingsworth, the computer would allow him to approve her application.
In an email he addressed to Dr. Moore-Hollingsworth (not her name), the supervisor said that until the names matched, the system, "physically will not allow us to move forward."
Moore is hilarious on the subject of this guy in Minnesota. (I decided not to identify him). She researched his LinkedIn profile and discovered his last job had been in lawn care.
"He's an idiot," she said. "I'm board certified in the state of Alaska to say that."
A spokeswoman for the company, Noridian Healthcare Solutions, said it had complied with Medicare rules, as it was required to do by contract.
I contacted the federal Center for Medicare and Medicaid Services on Monday morning and again Tuesday. A spokeswoman said the agency would not be able to respond until Friday.
Moore's attorney already told her not to change her name.
A different name in Medicare's database could cause problems with the many other entities that know her as Dr. Moore, including payers, licensing agencies, the Internal Revenue Service, her malpractice insurance carrier, and others. Since Medicare requires her to submit a picture of her office sign, she thinks she would have to change that, too.
After extensive back and forth and an unsuccessful attempt to enlist help from Sen. Lisa Murkowski, as well as intervention from the American Psychiatric Association, of which she is a distinguished fellow, Moore finally gave up. She refused to change her name and could no longer take Medicare.
But under Medicare rules, she also could not accept cash payment from those patients.
She sent a letter to each of them. But many couldn't find other providers.
For example, Larry Feeney couldn't find help for his wife, who has had five brain operations for epilepsy. Finally, Feeney called Moore again because his wife was having seizures.
He had quit his job to help her, instead working self-employed. He was relieved when Moore agreed.
"We're willing to pay when we can, whatever we can, to make sure my wife continues to receive her care," he said.
He didn't realize until I told him that Moore wasn't going to charge him.
"She didn't ask for any payment. She didn't set another appointment. She said it would be unethical to just walk away when someone is enduring seizures," Feeney said.
Ellen Jaffee of the American Psychiatric Association is still working on the problem, which she called, "Insane."
Jaffee troubleshoots all day for psychiatrists dealing with bureaucracy. She has never seen this particular problem. Normally, someone just overrides the computer.
But she said Noridian, the contractor, is unusually unhelpful. Working with Medicare is rarely easy.
"There's got to be someone who can get to the bottom of this," she said. "The problem is, when you call these places, when you call in on the 800 number, you get a low-level staff person who doesn't really understand what is going on. So you need to get in at a pretty high level."
She continued, "This will require many phone calls to people who won't be there and may not call back."
Why do we have this kind of bureaucracy? It probably began to stop people from cheating. Then it grew on its own. Now it eats money and consumes the time and spirit of doctors who could be helping people.
As Jaffee said, "It's just ridiculous, and I think the real problem is that stuff like this makes doctors leave Medicare, which means that patients can't get care."
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