The health insurance industry has slowly but surely hijacked and shackled the medical profession. By exploiting their expertise they make record profits at patient and doctor expense while failing to improve overall health. Sadly, providers have steadily marched deeper and deeper into the quicksand of insurance plan servitude and lost most, if not all, healthcare decision-making autonomy.
Providers now deal with an endless list of pointless rules favoring the health insurance industry. The public on the other hand is clueless as to what the insurance industry has done to doctors.
Here’s what the doctors get from the insurance industry after years of study:
- Take-it-or leave it one-sided contracts
- Lifelong servitude
- Heavily discounted, non-negotiable fee schedules
- An overhead that’s been driven to 70 percent by health plan “rules”
- No easy communication with insurance plan decision-makers
- Onus on physicians to verify plan “benefits” for individual patients
- Able to see patients only with referrals – usually with an approved service code
- Referrals good only for a limited time frame – no retroactive referrals
- Requires office personnel to request authorizations (typically from a non-medical intermediary working for the health plan) for every step of the physician’s evaluation and treatment plan
- Limits physicians ability to use state-of-the-art and innovative treatments by claiming they are experimental, wasteful or unneeded
- Some types of health insurance plans use the primary care physician (PCP) to determine authorizations – these are often delayed or without proper codes attached so patient has to be turned away from a specialist appointment – the PCPs have been hoodwinked into working as gatekeepers for health plans
- Require office personnel with coding expertise to file claims
- Claims need to be filed within a short time frame or get denied
- Claims purposefully lost or downcoded arbitrarily by health plans
- Claims bundled to deny payments for individual services
- Burdened with credentialing and recredentialing requirements
- Made to carry expensive malpractice
- Must complete burdensome CMEs periodically
- Must invest in expensive technology for medical records and practice “management” products
- Must submit to periodic medical records audits and clawbacks of payments
Visit www.HEALTHdrum.com to see how joining our healthcare community can get you better margins and lower overhead. Don’t let health plans play doctor and exploit your expertise.
Read more.
https://theconversation.com/why-insurance-companies-control-your-medical-care-62540
Written by HEALTHdrum