Archive for May, 2016

Be Careful when Swimming with Sharks by Andrew Wolfe

May 17, 2016

I have been retired since late summer last year and with 28 years behind me in private practice in medical massage it has been, at times, a difficult decision. One decision that was easy to make this transition, is working with the corporate world of insurance billing. One would think it would be the best interest of the individual, whose care determines an outcome of quality of life. But the illusion is shattered when the denials come rolling in, much less the high costs of premiums that come due month after month. I do have to say, I have had some rare cases, in which I have had very helpful representatives in the insurance field. One would assume they are like everyone else, just trying to do the best they can do and earn a living. But just “eking” by is not what living is. Comparatively, when one loses the precious community, such as health, one looks a little differently at life. It still doesn’t take the bite out of health care costs though. I realize too the small, albeit, costly fraud that can happen in insurance billing, which often times penalizes the “average Jo” based on “offset” higher premiums and reduced benefits.

When working as a sole proprietor several years ago, I received a correspondence from an insurance company, whom I was an individual subscriber to, notifying of a rate increase. As was noted in the letter, this was to help reimburse more fairly medical providers. “Great “I thought this includes me, as I was also a contracted provider with this specific insurance company. And just as I expected I received a letter from the same insurance company a week later. I opened it and was dumb founded; my contracted rate had been reduced! So much for corporate fairness. I was shock at the irony. I heard in conversation from other health care providers whom are contracted with insurance, that as in the case I was experiencing, they had to work harder, see more patients and get reimbursed less. Who were the ones receiving the price increase? In the 28 years of full time private practice I cannot say I have had reimbursements to offset any cost of living or cost of operating increase in regards to increase reimbursement. In fact the particular insurance company I mention prior reduced the reimbursement fee for service less than when I first contracted with them over 10 years prior. Some insurance companies had little to no cost increase to me as a practitioner, yet the individual mark up of policy holder was great as much as 200 percent or higher. Who are the ones after your interests? Just asking, because I don’t see it. A lot of folks I talk to describe insurance as “a necessary evil”. It is something you pay for in hopes you don’t need it but if you do the promise is you’ll be taken care of. I know others who complain about the premiums and want to use as much benefits as they can. Which to me is the wrong approach, but I understand the reasoning, especially for individuals to justify the cost. Still I have had others, most self-employed people I have spoken to, who say they rather take the penalty for no insurance than the cost of monthly premium that are out of reach to them. Others than have told me they will take their chances that they will stay healthy. Or better yet, I asked one self-employed individual what he did for health insurance; he informed me he did not have any. I asked what he would do if something major happen to him. He responded by say very directly without any hesitations or reservations, he would bankrupt. Medical and health costs are a major contributor to bankruptcy, not negligent debtors (although they account for some)! With that said there is something wrong with the system. I don’t subscribe to any particular solution, but simply see the brake down and failure of it. How can the corporate executive make healthcare decisions while overriding the patient’s needs, much less the attending doctor and/ or providers recommendations? When did corporate executive go to medical school or have any other medical training?  Just my 2 cents, for whatever its worth. Meanwhile, use your sunscreen and watch where you swim they just might be a shark or two lurking.

copy write 5/17/16

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