The doctor patient relationship has been destroyed due to the third party payer system. I am amazed at how the profession has been devalued. There is little credibility in being a Physician these days and after ten years of practicing medicine as a family physician I can tell you why. First and foremost is the means by which the insurance industry has played the doctor against the patient, the patient against the doctor, and even worse the doctor against the doctor. Secondly is the attitude that Americans have. Americans posses this sense of entitlement. It is embarrassing for me to see a man or women fight with my office staff over paying a $17.56 Medicare co-pay. Especially when I know they have more money than I do. Why do people think that just because they have insurance they do not have to pay the physician for his/her services.
Entitlement comes in many forms. In the case of medicine in comes in the displaced manner by which you as a consumer feel that just because you pay a third party for health care premiums, you think that you do not have any personal responsibility to the people who are actually taking care of you. Your Physician does not work for the Insurance company. They do not work for United Health Care, Aetna, Medicare, BCBS, Humana or any other company. They work for themselves or an organization that owns and operates the practice. Of course their are some doctors that do work for insurance companies, most notably Kaiser permante physicians, but this is the exception. For this reason the relationship between the physician and the patient has been ruined. When you have a personal experience with someone who you are paying for services rendered, then paying that person directly makes both you and them more responsible to each other. The minute you put someone in the middle, you have created several problems; 1. is a lack of responsibility and accountability to each other. It becomes to easy for the patient or physician/staff to get upset about something and then just go find someone else to deal with or for the staff to decide your too difficult and ask you to go find another doctor. A free-market system works because of accountability. If you provide a service or product that I like, I will continue to buy or use your services. If you don't, then I will go somewhere else. If however I am not the one paying the bill then I develop a sense of acceptance and allow mediocrity to take over. Too many patients expect the doctor to take what he gets from the insurance company and write the remainder off. One reason this has occurred is because too many doctors practice this way. It is easier to just write off the balance to put up with bickering and crying from the patients. It is also uncomfortable to ask patients for money when your in a profession that is all about caring and giving. Once one doctor does this then they expect all doctors to do this. As soon as a doctor sends a bill then the patients get defensive and start to question the doctors office. Entitlement in this case is defined as "I pay $500.00 a month to BCBS for insurance so that when I come to you for medical care I should not owe you a dime. The insurance companies are very smart. This is one of the systems they have put into play so that this relationship of friction exist. Why? So that they ultimately will find the doctors who are most likely to write off remainder amounts. By dong so they will find be able to have most of their patients going to a certain group of doctors. This allows them to manipulate the system. I will blog about the manipulation later and how the goal of the insurance companies is to find the doctor who is willing to take the least amount of money for the same services and thus ultimately control pricing. This is not free market but rather market manipulation. Back to my discussion. 2. The other thing that happens by putting a third party in between the consumer and supplier is a lack of trust and transparency. Instead of bills coming directly from the physician and going to the patient at the time of service, they go from the doctor to the insurance company. The insurance company does all this fine tuning adjustment to the bill, pays what they decide they owe and send off a complex EOB to patient and doctor. The doctor then has to make some elaborate, complex and time consumer postings to find out if there is or is not a balance and then send off the final bill to the patient. This process on average takes about 60 days and at this point the patient either conveniently or not forgot about the office visit and wonders why they are getting a bill so late. Often times the final billing to the patient can be delayed even longer in a small one or two person practice because of the lack of appropriate staffing that is required to handle all the BS that it takes just to get paid. 3. Finally is a lack of appropriate communication. I get a good laugh every tine a patient calls the insurance company about a bill we sent them and hears from some low level high school graduate that I coded wrong and that the patient needs to tell me they don't owe me anything and I need to re-submit the bill back to the insurance company with the proper codes. Can you say manipulation, brain washing, controlling, avoidance or responsibility, unethical and frankly in my opinion illegal.
Let me make one thing very clear to every consumer of health care and every young doctor entering the medical field. The goal of every insurance company is to find a way to deny medical claims. If you do not believe me then just watch the movie SICKO. They had a wonderful factual clip were an ex Human administrator testified in front at a Congressional hearing about how she was paid bonuses based on her ability to achieve a 15% denial rate each month for health claims from doctors offices. This is no joke. It is very real. I have had my staff on the phone talking to insurance company personal who have admitted to them that this was part of the job. I have been on the phone with the insurance commissioners office of North Carolina who has told me the same. How hard do you really think it is to cut a check to the doctor for services rendered. How complicated do you think the computer system needs to be for someone to post a bill and have the computer spit out a payment. It is not that hard. What takes so much staffing and technology is for the insurance companies to pay for all these employees to find ways to make the denials legitimate and believe me it is more profitable to deny claims or delay the payment of claims while the millions of premium dollars sits in a bank account earning interest then it is to pay $10.00 an hour to pay people to sit on the phone and talk to angry patients and doctors all day.
to be continue: please feel free to post a comment otherwise I will finish this blog at a later date..