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The Secret Side of Medicine

Oct 3, 2012 | Healthy Living | 0 comments

Today through Twitter I found a frightening article on the New York Times Website:

When Doctors Stop Taking Insurance

health insuranceThe article gave several examples of patients, all in Manhattan, who were paying up to tens of thousands of dollars for medical care, even though they have insurance.  Both my husband and I pay for private insurance, and with the amount we pay, I would be livid if we ended up paying out of pocket because we couldn’t find a doctor that took our insurance.

But as a doctor, I can understand why many physicians do not take insurance.  I recently moved to a new state, and I’m in the process of getting on all the major insurance plans, including Medicare and Medicaid.  What patients don’t realize, the so-called “secret side of medicine”, is that trying to get paid for being a doctor is often as much work as actually just being a doctor.  Let me explain.

Most people go to work, put in their time, and get paid.  This is obviously hourly pay.  Others are task oriented, and paid by a yearly salary.  But as a physician, you perform tasks such as seeing patients and performing surgery.  But then you have to prove that you did that work.  Let’s compare the process to doing paperwork to get a rebate.  Instead of proving you bought a product, you’re proving you saw a patient, or did a procedure.  The paperwork you submit to an insurance company is similar to the paperwork you turn in for a rebate.  But you obviously are busy seeing patients, so you have to pay another person (or two) to do this paperwork.  And just like with rebates, the rules and the paperwork are a little bit different for every insurance company.

So you get the paperwork in.  Now we take this comparison to getting a rebate a little further.  Just like with rebates, the paperwork gets lost.  Or if the insurance company doesn’t like the way you filled out the form, they reject your request for payment.  And just like with rebates, there is a big time lag of weeks to months before you get paid.

Now we’ll take the comparison in a different direction.  Imagine you can’t apply for the rebate without first becoming part of a special club.  Physicians can’t take insurance without first becoming an approved provider.  I recently moved to a new state, so I’m still going through this process.  I’m lucky because my hospital supports private physicians by having an organization to deal with the insurance companies.  So I didn’t have to negotiate with them directly to decide what they will pay me, but my office did have to fill out about 100 pages of forms.

Medicare and Medicaid are a little bit tougher.  So far we have submitted a full application.  When the Medicare office requested further information, we emailed them back the same day.  They lost the email, so now they’re requesting we fill out the 30-odd page form again.  We have called multiple times without a response.

Mind you, I am not complaining.  Patients who have insurance, Medicare, or Medicaid should absolutely be able to obtain health care with that coverage.  But when you have difficulty finding a doctor who takes your insurance, it may help your frustration when you realize that taking your insurance is the equivalent of filling out a rebate form, and hoping you get paid.  Would you rather fill out a rebate a wait, knowing there is a possibility you may never get it, or take cash in hand the same day?

Have you had trouble finding a doctor that took your insurance?  Or do you have another experience you’d like to share?


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