The insurance contracts that we are forced to sign are totally non-favorable toward the doctor. There are all sorts of rules and penalties and no benefits for the doctor other than listing his/her name in a directory. Currently, the AMA is trying to address the issue of health plans listing well respected doctors names to help sell the plan, even though those doctors are not in the plan.
The worst rules come from Medicare. It is an absolute nightmare since it is government. Workers Compensation used to be a reasonable insurance policy to accept. It used to pay 90% of usual fees with only a page or 2 of extra paperwork to do. In 2003 they changed the rules. If a doctor wants to see a workman's compensation case, he/she must first take a class for one week at his/her expense. Then the new fee schedule will be 3% less than what Medicare pays. Medicare was already at 29-32% of a doctor's normal fee schedule. This is already at a level that only covers overhead and nothing extra for the doctor to take home.
When I started in my new office 4 years ago, I was shocked at how many insurance companies would not reveal the amount that they would “allow” for office visits and procedures. They said that I would have to wait to see how much they would pay, after I signed a contract. It was “proprietary information”.
Many doctors as well as myself has tried to increase revenue by providing other services. I have had sales people show me how much I should get from a service. When I try to bill the insurance company, they say that they will not allow me to bill for that service since I am a family doctor and not a specialist. Also, since I have a contract with them, I cannot bill the patient for this service. I would have to eat the cost rather than have an additional revenue source. A few of the other services are considered medically unnecessary and the patient would have to pay for it themselves. This creates an awful amount of anger toward the doctor, unfairly.
It has been held up in court that insurance companies have no moral or ethical obligation to quality medical care. They are absolutely a company to make money and nothing more. All of their talk of quality healthcare issues is purely a cost reduction and savings to them by limiting the care that you the patients deserve.
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