Insurances Taking Advantage of Practitioners

[Dahlers and Sense]

So you think supply and demand has nothing to do with the OPs situation?

We are the only inpatient rehab hospital in a 100 mile radius. All the practitioners are independent and all have applied and been denied to certain insurances. So I’m not sure the issue is a supply and demand issue.

[jacoavlu]

so it seems there is a demand for your services, in this case you are applying no pressure on the insurance companies, if you're only charging medicare rates out of network, and you've accepted a lowly 60% rate from BCBS

get together with your colleagues and form a group and charge higher rates, patients will complain to their insurance who may then be motivated to negotiate with you

[Eye3md]

I wish I had advice... I was even going to post about my brewing "war" with an insurance company. Their pay has been terrible, less than 50% of Medicare, but understandably it is state HMO Medicaid. Not a single increase in reimbursement in over 4 years. Every time I request an increase their response is "we don't have it in the budget".

Last week they sent me a letter & I probably can't get into specifics, they used some words that I find personally offensive to my character, & as a doctor. I have plans to contact the provider representative about it. If we can't agree to resolve the issues in the letter or provide me with a rate increase, I will be pulling myself from their network. This company represents ~20% of my yearly income. But the work amount & stress level are more than my typical Medicare patient, so I don't think I will cry about it.

All that is to say, going in I knew one day they would be on my chopping block. I have always looked at it as certain income. No deductible, no copay, no coinsurance. And one day when I didn't need their stability, I would be cutting them. You, Dahlers and Sense, might want to see your situation this way. Maybe bite the bullet for now & re-assess in the future. It is off putting to say the least, but sometimes it works out in other ways.

Another specialist near me cut the same insurance I'm fuming with last year so I got a influx of patients looking for an in network doctor then. I completely knew why he did what he did, he wasn't wrong. Now I'm in his shoes.

We've used this to our advantage before. If enough patients lose access to doctors nearby, then they start raising cane with the insurers. If none of the docs in your area took these crappy rates, then the patients would have no place to go and would complain bitterly. We've been in battles before where I would simply tell my patients "we will probably drop from that insurance plan soon because they are being unreasonable". Tell enough patients, and then they start calling the insurance company, and it can help A LOT.

If if only us docs would work together more. Problem is, we are all worried about losing business so the insurance companies know they can offer these low ball Mediciare rates and someone will bite

[EM-CCM MD]

Start sending letters with the bills.

Dear Mr. X,

I’m so sorry. I normally just get paid by the insurance company. I’ve repeatedly tried to be an “in-network” Doctor with your insurer because it’s the right thing for patients, but your insurer refuses to let me be an in-network doc. There is no reason for this other than they don’t want to cover your bills. This really should be handled by your insurance company. All services and bills from me are customary and should be covered by any reasonable insurance contract, but your insurer doesn’t want to keep up their part of the contract so they decide to exclude physicians from their networks. If you have a problem with policy, please contact the complaints department of your insurer at XXXX. The personal line to the highest ranking person I can find is XXx and his/her office is room Xxx at address XXX. Again, I’m really sorry and it was a pleasure caring for you and your loved one. Please find the attached bill.

sincerely,
Dr. EM/CCM

[Tim]

Dear Dr. EM/CCM,
I was a patient in room 301 for 48 hours. My hospital and physicians were confirmed at this facilty to be in network. The hospital bills the insurance company directly.
On your behalf, let me know who you want me to complain to at the hospital on your behalf. I certainly hope you as a physician realize that my contract for care was with the medical facility. If you are not getting paid, then there is a problem with your employment contract. We never contracted and I had absolutely no role in the matter. I did not pick the food, or the nurses or the person that changed the sheets. Let me know who in the hospital needs to resolve the lack of payment of your wages.
Thank you kindly for giving me the opportunity to practice. Those dang shots hurt like ...... well it was a PITA.
Best wishes with your contract issues. I don't think its right that the insurance company and hospital get away with this crap.

[jacoavlu]

Tim

The OP is not employed by the hospital.

Any patient admitted will sign a financial agreement that says they will be responsible for charges not covered by their insurance company. If the hospital credentials physicians not in network with major payers, well...

No one would confirm that all physicians in the facility are in network, if that is not true. If someone did confirm such, that is a mistake and not the fault of the OP

[Tim]

We are the only inpatient rehab hospital in a 100 mile radius. All the practitioners are independent and all have applied and been denied to certain insurances. So I’m not sure the issue is a supply and demand issue.

What would a hospital without physicians do? Close? Logical solution. On a serious note, hospitals are closing and it sounds like that is the direction this one is going. Community hospitals can cease to exist suddenly or slowly. One option is for you and the other three to seek greener pastures. Purely speculation. Let the other that so badly want a poor imbalance take the hit.

[Tim]

Tim

The OP is not employed by the hospital.

Any patient admitted will sign a financial agreement that says they will be responsible for charges not covered by their insurance company. If the hospital credentials physicians not in network with major payers, well...

No one would confirm that all physicians in the facility are in network, if that is not true. If someone did confirm such, that is a mistake and not the fault of the OP

The Evil Banks and Payday Loan companies and the bandit movers and con-men doing disaster repairs use the same pitch : You signed a CONTRACT! It's actually amazing when a hospital administrator comes into a hospital room with some papers to be signed AFTER the fact. OP wasn't employed by me either. For all I know the hospital is charging for new roofs, of course medical insurance won't pay for that. They way it is worded, the hospital may actually bill for zero and everything including cute new scrubs are dumped on a bill.
My response is "show me the contract". It doesn't work but it won't be a pleasant experience.
BTW, I am actually on the physicians side, the problem is with the system. There are many ways to jam the system up and make it grind oh so slowly that someone someplace decides to come to a legitimate compromise. It's a PITA and inefficient for the hospital, insurance, and creates a lot of protests and needless inefficient paperwork that requires responses. My personal preference is the hospital would negotiate in network rates that physicians can use in the absence of a separately negotiated rate by the physician.
NO staff wears a tag that says W-2 or 1099.

[Zaphod]

And you can deal with them, as long as they aren’t a concern for you, but you don’t have to.
That is exactly the definition of a free market. Everything else is negotiable.
By no means is free market fair.

uh no.

Insurance is how almost every single doctor in america gets paid. You have to deal with them outside of cash pay which is difficult to do, precisely because it is not a competitive free market. Having all the leverage on one side is not in any way close to being a free competitive market.

If you decide not to take insurance, even if you're not boarded and get dropped from panels, you essentially cannot work. Please tell me how this falls under any reasonable definition of free market.

Doctors do have to. They also mostly 'have to' deal with hospitals as well.

Sure, doctors could exert more pressure but it would literally take changing the laws of the land and getting people to actually do so, which has never happened before.

[Zaphod]

So you think supply and demand has nothing to do with the OPs situation?

That has nothing to do with healthcare on the whole being a free market or not, thats a local phenomenon and one insurers have been okay with ignoring in the past.

Having a single tiny semblance of a property that is found in competitive free market systems does not make it free market. Just as were not a fully capitalist society, etc...etc...

[jacoavlu]

Zaphod I guess you would say then there is absolutely nothing the OP (or any physician for that matter) could do?

[Tim]

Employment models change. A free market let’s markets determine the outcomes.
Maybe a doctor’s union? Would that not be a free market? Employed physicians union? Physicians groups? Sole proprietorship ? Individual employed? The power to negotiate and get paid can be individual or group. All those are options and exist currently for physicians. An individual physician may find one method has terrible results in various situations. That is still free. Requiring an employer to contract is not free.
Yes, it’s sometimes “unfair”. They were free to refuse. Adding a requirement that mandates “yes” is not “free market”, it’s a restrictive requirement.

[zlandar]

Are there any clinically integrated networks available at the hospitals you work at? I am a part of one and bill insurance companies under their negotiated rates. The rates are significantly better than what most groups could negotiate by themselves.

[Zaphod]

Zaphod I guess you would say then there is absolutely nothing the OP (or any physician for that matter) could do?

Thats a wholly different argument. Makes no difference as to whether its a free market or not and of course there are degrees.

[toofy]

So you think supply and demand has nothing to do with the OPs situation?

No. This is a contract of adhesion. Google it.