Comments on: Health Insurance Companies Take Advantage of Doctors, Part V http://www.citizeneconomists.com/blogs/2008/10/15/health-insurance-companies-take-advantage-of-doctors-part-v/ Citizen Economists is an online economics magazine written by citizen journalists. These ordinary citizens provide reports and commentary on the current events affecting the economics of the fields they work in. Fri, 30 Jul 2010 05:03:49 -0400 http://wordpress.org/?v=2.8.4 hourly 1 By: XSmith http://www.citizeneconomists.com/blogs/2008/10/15/health-insurance-companies-take-advantage-of-doctors-part-v/comment-page-1/#comment-12738 XSmith Wed, 24 Jun 2009 19:56:56 +0000 http://www.amateureconomists.com/blogs/?p=335#comment-12738 Thank you for comments and these good articles.I am in a big problem with the insurance companies.I am in UK. Everything you are saying is exactly the same here, but there is a difference... .Insurance companies are accusing doctors of unbundling when in fact is them bundling and forcing to make huge repayments retrospectivey...If you don't pay they will suspend you and your whole practice follows.I am an anaesthesiologist, I get a mixture of cases from different companies in a day.I can't say to the surgeon I do "a" but not "b" but yes "c". The surgeon will stop working with me... The worst has happened to me.... as they know they may loose in court for their practices they have reported me to the General Medical Council, accusing me of fraud, unbundling...these can have serious implications and destroyed my whole life and career.I am desperate because I am just a small fish against these companies..My family, my wife is very supportive, thank God, but my kid knows I am not the same and he senses how much I am suffering...To make it even worse my wife is pregnant of our second kid and instead of enjoying the pregnancy we are suffering largely...i am having daily nightmares of being derecognize by the GMC, they work "defending" the public from the doctors. This is surrealistic.I have learnt in 2 months something really awful. Anybody can make you feel guilty,it is difficult to keep your head up when you see the insurance companies turning the story to their advantage. Thanks for listening... Thank you for comments and these good articles.I am in a big problem with the insurance companies.I am in UK. Everything you are saying is exactly the same here, but there is a difference…
.Insurance companies are accusing doctors of unbundling when in fact is them bundling and forcing to make huge repayments retrospectivey…If you don’t pay they will suspend you and your whole practice follows.I am an anaesthesiologist, I get a mixture of cases from different companies in a day.I can’t say to the surgeon I do “a” but not “b” but yes “c”. The surgeon will stop working with me… The worst has happened to me…. as they know they may loose in court for their practices they have reported me to the General Medical Council, accusing me of fraud, unbundling…these can have serious implications and destroyed my whole life and career.I am desperate because I am just a small fish against these companies..My family, my wife is very supportive, thank God, but my kid knows I am not the same and he senses how much I am suffering…To make it even worse my wife is pregnant of our second kid and instead of enjoying the pregnancy we are suffering largely…i am having daily nightmares of being derecognize by the GMC, they work “defending” the public from the doctors. This is surrealistic.I have learnt in 2 months something really awful. Anybody can make you feel guilty,it is difficult to keep your head up when you see the insurance companies turning the story to their advantage. Thanks for listening…

]]> By: james http://www.citizeneconomists.com/blogs/2008/10/15/health-insurance-companies-take-advantage-of-doctors-part-v/comment-page-1/#comment-5661 james Wed, 28 Jan 2009 02:13:18 +0000 http://www.amateureconomists.com/blogs/?p=335#comment-5661 Thank you for your interest in this area. I am a specialty physician who has headed a 5 person group for the past 19 years. Over the past 14 years we have seen our overall reimbursement rates drop from over 90% to under 40%, while not raising our charges for services over the same time. We have had to substantially reduce the time we spend with patients versus documenting in charts. We have had to more than tripple the size of our office staff to file initial claims and follow up on denials. Insurance companies dictate not only our payments, but also our practice of of medicine. They repeatedly deny payments for recommended testing and treatments without "additional clinical information" as though someone in their company had better judgement and insight into the patient's problems than do we. They frequently require preauthorization for testing. Then, it can take hours of employee time to wait on hold to get prior approval, and even after approval is obtained, they do not guarantee payment for services rendered. In addition, each insurance company establishes its own rules for which testing/treatments require prior approval and those rules are constantly changing. Most of the time, I could complete a substantial portion of needed testing before the patient leaves the office at the first visit, but this is not allowed. Only one charge (the cheaper) for either an evaluation or testing is permitted on the same day. Unfortunately, the patient has to schedule a return visit for testing and treatments. If the patient does not return, then the insurance company saves money. Even if the patient does return, the insurance company saves the time value of the money. This is the same savings they enjoy by delaying payments to providers by requiring them to provide "additional information" before making payments . Another method for reducing payments to physician providers employed by insurance companies is auditing patient charts. This is essentially cost free to the insurance company, while costing the physician hours of employee time and worry . They simply contract with a company to audit for them and pay them a commission based on the amount recovered from the physician. I could go on and on. Again, thank you for your interest. Thank you for your interest in this area. I am a specialty physician who has headed a 5 person group for the past 19 years. Over the past 14 years we have seen our overall reimbursement rates drop from over 90% to under 40%, while not raising our charges for services over the same time. We have had to substantially reduce the time we spend with patients versus documenting in charts. We have had to more than tripple the size of our office staff to file initial claims and follow up on denials.
Insurance companies dictate not only our payments, but also our practice of of medicine. They repeatedly deny payments for recommended testing and treatments without “additional clinical information” as though someone in their company had better judgement and insight into the patient’s problems than do we. They frequently require preauthorization for testing. Then, it can take hours of employee time to wait on hold to get prior approval, and even after approval is obtained, they do not guarantee payment for services rendered. In addition, each insurance company establishes its own rules for which testing/treatments require prior approval and those rules are constantly changing.
Most of the time, I could complete a substantial portion of needed testing before the patient leaves the office at the first visit, but this is not allowed. Only one charge (the cheaper) for either an evaluation or testing is permitted on the same day. Unfortunately, the patient has to schedule a return visit for testing and treatments. If the patient does not return, then the insurance company saves money. Even if the patient does return, the insurance company saves the time value of the money. This is the same savings they enjoy by delaying payments to providers by requiring them to provide “additional information” before making payments
. Another method for reducing payments to physician providers employed by insurance companies is auditing patient charts. This is essentially cost free to the insurance company, while costing the physician hours of employee time and worry . They simply contract with a company to audit for them and pay them a commission based on the amount recovered from the physician.

I could go on and on. Again, thank you for your interest.

]]> By: SJ Robinson http://www.citizeneconomists.com/blogs/2008/10/15/health-insurance-companies-take-advantage-of-doctors-part-v/comment-page-1/#comment-2055 SJ Robinson Thu, 16 Oct 2008 15:16:10 +0000 http://www.amateureconomists.com/blogs/?p=335#comment-2055 One more example of how insurance companies maximize profit. They clearly know what they are doing. Though I say in my article on Health Care Reform that class actions and lawsuits in general should be a last resort, this looks like a case for a class action. Obviously they have the same practice with others. It is also an illustration of why we need health care reform. Hopefully if Obama wins, this type problem could be solved by government oversight in the health care insurance registry that he advocates. One more example of how insurance companies maximize profit. They clearly know what they are doing. Though I say in my article on Health Care Reform that class actions and lawsuits in general should be a last resort, this looks like a case for a class action. Obviously they have the same practice with others. It is also an illustration of why we need health care reform. Hopefully if Obama wins, this type problem could be solved by government oversight in the health care insurance registry that he advocates.

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