You’ve had a chance to consult with us, you’ve visited the web site and done your research on modern surgical techniques for bunion surgery, you have health insurance and are ready to schedule your procedure… so what now?
There is a lot more that happens in the background that you are not informed of. My goal is to shed some light on the process of how insurance companies operate and how they deal with us, your health care providers, so that my patients, and thousands of other Americans can be well informed consumers when choosing a health insurance policy, and more importantly, what to demand from their insurance providers.
Most health insurance companies are large “for-profit” corporations. This means that in order for the company to increases profits, they must either lower reimbursements to doctors, or raise premiums for the insured. To bring reimbursements down, insurance companies tie contracts with doctors to perform procedures for a discounted rate.
This ultimately effects the practice of medicine in a negative manner since the cost of practicing medicine, and operating a business continues to go up. The result is doctors’ offices have increased the volume of patients they see and procedures they perform in a day to cover always increasing costs, and reduction of reimbursements.
Since it’s inception day, Beverly Hills Aesthetic Foot Surgery has been committed to the practice of excellence and quality in Podiatric Surgery. To achieve this, I have committed to a small footprint high quality practice. Where other offices have 4 or 5 treatment rooms, we only have two. Most practices in the U.S. currently contract with one or more of the major insurance providers (this continues to contribute to the reduction of quality of care that is derived from increase in volume); we only contract with non-profit insurance companies.
Click to See the Equation...
Contracting with insurance companies means you have to see more patients per day because of the reliable reduction in reimbursements. Increased volume means decreased quality. Not an acceptable equation in my practice.
So I saw it as an ethical decision, and decided to cancel all of our contracts with for-profit insurance providers. You might be asking yourself, as many of our patients also do: “Can I still be treated at your office if you are out-of-network or not contracted with my insurance provider?” Yes, you can. Most insurance plans offer out-of-network coverage, giving you the power to decide who treats you. This is something you should demand and expect from your insurance provider. This keeps the system honest but more importantly it gives the patient the power to decide what they consider a quality practice and who they choose as their doctor.
We pride ourselves on educating and helping our patients in every way possible to ease the navigation of the quagmire the insurance industry has created. We often serve as patient advocates and conference call with insurance companies to expose the unfortunate and unacceptable mediocrity they perform their duties with.
Our ethics don’t stop with contracts though. Clear pricing and up front transparency on the costs of your procedure is another tenet of our practice. This would be simple if the insurance industry played fair and gave their clients a copy of the Current Procedural Terminology (CPT) code book and the payments they allow for each code. Just like when you dine at a restaurant the prices are marked clearly so you know in advance what the items cost.
We are not so lucky in medicine. Insurance companies regularly restrict access to the fee schedule and clear break down of expected payment. This limits our ability to give our patients what they rightfully deserve, a clear breakdown of their expected out of pocket expenses before surgery is scheduled. The hidden fee schedule is another sad result of a for-profit insurance company.
This is why I urge every one of you to call your insurance companies and demand that they release a complete fee schedule to you so that you can be aware of what your costs will be before you consider treatment. This expected reimbursement model is followed by every other facet of insurance except for health. Consistent with our patient centric philosophy, our practice operates with open transparency. Upon your request, we will give you the codes that we will be billing so that you can have the exact cost for your procedure (given that your insurance company complies with your requested copy of the current fee schedule).
This saddens me because in the end, we the consumers lose.
My promise to you and every future patient is that we will stand resolute giving our patients what they rightfully deserve: the practice of podiatric medicine at the highest level without compromise in personal attention, technological advancement, or procedural innovation. I believe in this so much that I had it painted onto our OR wall…
