Why many medical providers hate health insurance companies.
Do you have a job? I am sure it has a paycheck attached to it or you probably wouldn’t stay there. I’m pretty sure that you had to sign some kind of employment contract that spelled out your responsibilities and your salary, the responsibilities of your employer, dates of review and so on.
Doctors have to do the same thing with insurance companies in order to accept patients who have that kind of insurance. It is called being “in network” with that insurance company.
Being a medical provider is just like being an employee of many insurance companies (being “in network” with many insurance companies). Except for a few differences that you would not tolerate in your contract with your employer.
1) As an example, a doctor has a procedure he charges $75 for. In his agreement with the GGG insurance company that he is now in network with he agrees to earn $55 for doing that procedure on a patient of that insurance company. In exchange, the insurance company promises to send patients to that provider. Less pay but more patients. It seems ok on the surface.
It seems like a good idea: you make less money per visit, but you get more patients to treat an therefore you make up the loss of income with volume.
Now comes the part we hate:
a) the insurance company doesn’t send or refer any patients to you.
b) you finally get a patient who has GGG nsurance. They saw your sign and they came in to see you – it had nothing to do with the GGG insurance company referring a patient to you.
c) when you treat the patient the GGG insurance company sends you $40 for the procedure they said they would pay you $55 for doing. Remember, you usually make $75 for that procedure but you agreed to earn only $55, originally.
Why did the GGG insurance pay you only $40 of the $55? It seems that in that contract you had to sign to be in the GGG network that had a clause that they could change the payment to you when they feel like it, all they have to do is inform you. Or not inform you, it doesn’t really matter – failure to inform you is not their problem.
d) you won’t tolerate this lousy contract with the GGG insurance company! You intend to quit and not accept any more of their patients. It seems, you can’t just leave!
1) You must finish the contract with the GGG company or you are in violation of the contract – an ugly legal problem! Except that it is the length of the contract plus 90 days. That is 90 days after they have accepted your letter of termination (which must be filed at least 90 days before the contract end date).
If you miss the 90 days before the end date of the contract to get that letter to them by certified mail you are automatically signed up for another 2-3 years with the GGG insurance company, plus 90 days.
2) While you are in contract with the GGG insurance company you cannot refuse to see their patients, at the new reduced amount you wouldn’t have agreed to if you had known how little they pay.
3) OK, now you are out of that horrible contract – you met the 90 days that you had to submit the termination of contract letter, you stayed the extra 90 days that the contract stipulated and you are done with them. You intend to go back to filing for the “out of network” rate for any patient you get who have the GGG insurance (which is usually substantially more than the “in network” rate).
You can do that, except if you still have that patient you got while you were still “in network” with the GGG company – that patient will always be paid at the “in network” rate because you got them while you were “in network”.
Now multiply that times all the companies you are “in network” with. It is a nightmare.
This is why Chiropractic Lane is proud to be “out of network” with most insurances. We want a fair relationship with our means of payment.
There is more to the problems medical providers have with insurers with the insurers not paying us to perform procedures that the insurer doesn’t want to pay for. The provider is stuck with doing procedures for the patients that we think are helpful and useful and not getting reimbursed or not doing them (despite the necessity) so we don’t waste our time doing something we don’t get paid for. Some doctors have gone to the patient and requested payment for the procedure or had the patient pay them altogether and filed paperwork to the insurer for as much as they can get to the patient as reimbursement!
So imagine your life if your employer could (a) change the amount he pays you, (b) hold you to the bad employment contract despite how they unilaterally changed it, (c) demanded excellent work from you and a good attitude (no badmouthing!) while you did your work on their clients.
So, most medical providers love patients and hate how they get paid!
via Blogger http://chiropractic-lane.blogspot.com/2013/08/why-many-medical-providers-hate-health.html
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