Imagine going to a restaurant and being given a menu. You are ready to order and meal, and fully intend to pay for it, but when asked about the prices (because there are missing) you are told by the owner that you are not entitled to that information.
Now this scenario is actually better than what your insurance companies consider normal. In the restaurant model, you are not paying a monthly premium for services that you expect to be rendered. In the restaurant, you can get up and walk out, walk down the street and sit at another establishment to get the meal you expect for the price you are informed of up front.
This discussion is about the elusive Fee Schedule. This is a point of contention for many doctors and unfortunately ends up giving many patients grief. Ultimately it is important to remember that the consumer controls the deck, and if you as intelligent consumers demand Fee Schedules of your insurance providers and demand that your physicians are given detailed fee schedules as well, things would change.
The problem is that when you see your doctor, you are under the impression that you have insurance, so you will only be responsible for specific costs that you were informed of by your insurance broker or agent. Costs like co-pays, deductibles, and co-insurance. The thing that everyone leaves out is what is the fee schedule that these costs are calculated from? Most of our patients come to our practice because we provide a service, at a level that far exceeds any office they have been to before. We pride ourselves on this and are humbled by the thousands of patients who come to us from all over the globe. And as I have discussed in previous articles, the formula to excellence and high quality care is simple… low volume. To make this happen we choose to stay out of network with most insurance companies. This however, places our practice in a precarious position.
Being out-of-network means we are not contracted with insurance companies and do not agree to participate with their restrictive activities. To limit their costs, insurance companies play an unfair game of penalizing their insured if they choose to go to an out-of-network physician. Now here is where it gets interesting… let’s say you are okay with these shenanigans because you really want to be at a high quality facility like ours; you are entitled to know what your out of pocket expenses would be… right? According to the insurance providers, you are not.
Every week, we spend hours on the phone conference calling with our patients and their insurance providers demanding that the insurance provider play fair and give a clear fee schedule to the insured so that they can know in advance what they can expect to pay out of pocket for the expenses of their procedures. We do this because we feel strongly about this issue. The insurance company works for you. You pay them a premium and they in return are providing you a service. The fact that they consider it acceptable to restrict your access to their Fee Schedule is a clear indication how they perceive their role in this relationship.
We conference call with you because the insurance company has call center employees answering the phones who have no vested interest in your well being. There is no reason for them to help you get quality care, after all, they are not providing you the care, we are. They are only the middle man determining where your premium dollars should go. When we get on the phone with you, the insurance company cannot get away with snowing you with terms you are unfamiliar with and explanations that make no sense to the patient. Rather, you have an advocate on the phone with you that deals with insurance companies every day and is going to serve as your liaison, standing up for your rights.
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I’ve been told by colleagues and patients that I take this insurance thing way to seriously. There is a reason for this. The health insurance industry has been instrumental in destroying the quality health care system our country had. They have controlled both sides of the field and have created a closed market that doesn’t allow for quality care to flourish without restriction.
As an ethical American, I cannot cower and let this continue. An article published in the Wall Street Journal, June 25th, 2009 outlines how United Health Care and their subsidiary Ingenix Inc. underpaid doctors and hospitals who were out-of-network due to flawed databases. It is crucial that you understand that Ingenix acquired the Lewin Group who released the most optimistic assessment to date of President Obama’s health insurance reform plan. Lewin is a leading source of independent, nonpartisan health policy analysis for the U.S. Government. Despite assurances given in June 2007, however, no corporate policy has been written to protect Lewin from interference by it;s parent companies… Ingenix Inc., which is United Health Care.
This form of corruption has to stop. You as the consumer can stop it, and you can count on us to support you.
