{"id":3167,"date":"2021-10-02T09:00:43","date_gmt":"2021-10-02T09:00:43","guid":{"rendered":"https:\/\/healthdrum.com\/?p=3167"},"modified":"2021-10-12T15:47:46","modified_gmt":"2021-10-12T15:47:46","slug":"how-the-health-insurance-industry-has-hijacked-the-medical-profession","status":"publish","type":"post","link":"https:\/\/healthdrum.com\/blog\/how-the-health-insurance-industry-has-hijacked-the-medical-profession\/","title":{"rendered":"How the Health Insurance Industry Hijacked the Physicians"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here\u2019s what the doctors get from the insurance industry after years of study:<\/span><\/p>\n<ul style=\"line-height: 1.6;\">\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Take-it-or leave it one-sided contracts\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Lifelong servitude<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heavily discounted, non-negotiable fee schedules\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">An overhead that\u2019s been driven to 70 percent by health plan \u201crules\u201d\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">No easy communication with insurance plan decision-makers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Onus on physicians to verify plan \u201cbenefits\u201d for individual patients<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Able to see patients only with referrals &#8211; usually with an approved service code<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Referrals good only for a limited time frame &#8211; no retroactive referrals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Requires office personnel to request authorizations (typically from a non-medical intermediary working for the health plan) for every step of the physician\u2019s evaluation and treatment plan<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Limits physicians ability to use state-of-the-art and innovative treatments by claiming they are experimental, wasteful or unneeded\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some types of health insurance plans use the primary care physician (PCP) to determine authorizations &#8211; these are often delayed or without proper codes attached so patient has to be turned away from a specialist appointment &#8211; the PCPs have been hoodwinked into working as gatekeepers for health plans<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Require office personnel with coding expertise to file claims<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Claims need to be filed within a short time frame or get denied<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Claims purposefully lost or downcoded arbitrarily by health plans<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Claims bundled to deny payments for individual services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Burdened with credentialing and recredentialing requirements<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Made to carry expensive malpractice<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Must complete burdensome CMEs periodically<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Must invest in expensive technology for medical records and practice \u201cmanagement\u201d products<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Must submit to periodic medical records audits and clawbacks of payments<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Visit <\/span><a href=\"https:\/\/healthdrum.com\/\"><span style=\"font-weight: 400;\">www.HEALTHdrum.com<\/span><\/a><span style=\"font-weight: 400;\"> to see how joining our healthcare community can get you better margins and lower overhead. Don\u2019t let health plans play doctor and exploit your expertise.<\/span><\/p>\n<p><strong>Read more.<\/strong><\/p>\n<p><a href=\"https:\/\/theconversation.com\/why-insurance-companies-control-your-medical-care-62540\">https:\/\/theconversation.com\/why-insurance-companies-control-your-medical-care-62540<\/a><\/p>\n<p style=\"text-align: center;\">Written by HEALTHdrum<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":3168,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[15],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>How the Health Insurance Industry Hijacked the Physicians | HEALTHdrum<\/title>\n<meta name=\"description\" content=\"The health insurance industry has slowly but surely hijacked and shackled the medical profession.\" \/>\n<meta name=\"robots\" content=\"index, follow, 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Subsequently, he completed fellowship training in Pediatric and Adult Reconstructive Urology at the Eastern Virginia Medical School in Norfolk, Virginia. During his time there he also undertook NIH sponsored, pioneering research on \u201cUrinary Bladder Reinnervation\u201d earning him the honor of a Masters of Surgery Diploma through the University of Otago, New Zealand. Dr Vorstman returned to Miami to become a board-certified faculty member in the department of urology, Jackson Memorial Hospital, University of Miami. Eventually, he left academic practice, moved north to Coral Springs and established Florida Urological Associates pa (www.urologyweb.com) in 1987. Dr. Vorstman is passionate about consumer-directed healthcare and helping men diagnosed with prostate cancer navigate the minefield of prostate cancer misinformation. 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Subsequently, he completed fellowship training in Pediatric and Adult Reconstructive Urology at the Eastern Virginia Medical School in Norfolk, Virginia. During his time there he also undertook NIH sponsored, pioneering research on \u201cUrinary Bladder Reinnervation\u201d earning him the honor of a Masters of Surgery Diploma through the University of Otago, New Zealand. Dr Vorstman returned to Miami to become a board-certified faculty member in the department of urology, Jackson Memorial Hospital, University of Miami. Eventually, he left academic practice, moved north to Coral Springs and established Florida Urological Associates pa (www.urologyweb.com) in 1987. Dr. Vorstman is passionate about consumer-directed healthcare and helping men diagnosed with prostate cancer navigate the minefield of prostate cancer misinformation. After retiring and leaving colleagues to continue the urology practice, he became founder and CEO of a healthcare platform that connects buyers and sellers of routine, cash pay healthcare services - www.HEALTHdrum.com\/ Through this platform he also enables colleagues to reclaim their profession from health industry exploitation. 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