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A Doctor's Experience With Medical Insurance
By Lisa Simmons
Many people have complaints regarding the cost of their medical and the difficulties they deal with in getting their expenses covered, but few are aware of the problems doctors have dealing with those same medical companies.
A family practice doctor was a provider for a large company covering many patients in her semi-rural practice. She employed several local people in the practice and had significant payroll and expenses to meet. One month she electronically filed about $15,000 worth of claims to this company. Time passed and she received no payments. Meanwhile she had to borrow to meet payroll. Finally she contacted the company. They told her that they had never received the claims and that she would have to contact the electronic claims company. When she contacted the electronic claims company, they told her everything had been done properly and that the problem lay with the medical company. She went back to them, and they told her she would have to resubmit all the claims electronically again. So she paid her people to resubmit them. Then she received a denial of payment from the company because she did not file the claims in a timely manner!
In another case, an internal medicine specialist was consulted in the hospital management of a very sick elderly patient by that patient's family doctor. The specialist became the primary manager of the patient's complicated medical problems, and the family doctor did little. Sometime after the end of the six-week hospitalization,
the specialist filed a claim with the patient's medical company for the extensive services provided. The family doctor had already filed his charges. The specialist received a payment of $8 as the company stated those services had already been reimbursed.
A patient's medical company changed its formulary, and the medicine that had served her well was no longer covered. She had to switch to one in the formulary. That medicine did not work. She was told to have her doctor fill out a special authorization so the first drug would be covered. The doctor filed the paperwork. The company refused to cover the medicine, and told the patient the doctor was not handling the situation properly. She complained to the doctor, who again put in another authorization and even spoke to someone at the company. The company still refused to cover the drug and again blamed the doctor. The patient demanded that the doctor take care of it. When the doctor explained he had done everything he could to get it covered, the patient cried and accused the doctor of not taking proper care of her, never doubting the words of the company.
Numerous problems with medical companies affect both healthcare providers and patients; these are a very few examples. Medical costs are out of control, in many ways because of the actions of these companies who are only interested in their bottom line. The business model does not work well for medical care; it should be treated as a not-for-profit service.
Lisa Simmons writes about medical insurance and other topcs of similar health nature.
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