Web Log – July 2016 – Insurance Hurdles

When I chose my photo of the month, a picture of cascading steeplechase runners going over a hurdle, I was reminded of a New York Times article that was recently referred to in an AMA blog.  The article referenced insurance company constructed hurdles to care.  The excerpt below was taken from the article, by Vastal G. Thakkar, MD dated June 30, 2016.

“Wendell Potter, a former Cigna executive turned whistle-blower and a co-author of the recent book “Nation on the Take,” says that “insurance companies profit by introducing hurdles in the coverage and claims process.” These hurdles lead some patients to simply give up and pay or forego treatment altogether. He calls this the companies’ business model.”

We have seen this insurance company behavior regularly.  Some insurers are better than others and some are worse.  We particularly are astonished when we receive a pre approval for a service and are then denied when the service is billed.  I will not even go into the usual payment delays the practice faces as this does not and should not concern the patient. Certain payers are so poor that it would cost the practice to treat patients, so those plans cannot be accepted.

We are fortunate to have an experienced and relentless manager, Lea Driever, who advocates for our patients.  While these troubles have driven doctors in general to join large hospital practices and some colleagues to drop insurance based surgeries, I will continue a balanced cosmetic and reconstructive practice as long as possible.  I believe the diversity is good for a surgeon and I enjoy the broad spectrum of patients.

Mark D. Wigod, MD, FACS, providing Cosmetic and Reconstructive Plastic Surgery to Boise, Meridian, Treasure Valley and Southeastern Idaho.

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