Anthem Bypassing Doctors
Here is an incredible tale, that seems like a fable, until you realize that an insurance company is involved. Anthem is being sued by doctors because they are “paying patients directly in an effort to put pressure on health care providers to join their network and to accept lower payments”. What does that look like? Well,
- A woman received nearly $375,000 from her insurance company over several months for treatment she received at a California rehabilitation facility.
- A man received more than $130,000 after he sent his fiancée’s daughter for substance abuse treatment.
In fact, Anthem supposedly sent “more than $1.3 million in payments to patients — money, the suit claims, that is owed to the facilities that treated people with addiction and mental health problems.”
What are the chances that:
- These patients will give the money to the doctors?
- These will use this money to treat their addiction with their own remedies?
Before you answer that, please know that patients who “receive money from insurers typically cannot be held criminally responsible if they never turn the cash over to their provider. But the patients can be held financially responsible.” Yeah, so that money is not coming back.
The bottom line is that this is about “out-of-network” care that insurers hate. So, they are torturing doctors to go chase the money in order for get them to bend the knee. And they have done it before and have been sued for it before.
Tell me why we have third parties in the middle of our healthcare system again? And, no, I don’t want a government run system. Our only hope is a proper free market.
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That’s how I was treated when I first started in private practice (Orthopaedic Surgery). Blue Cross wanted me to pay hundreds of dollars annually in order to have assigned payments sent directly to me (and wanted the money before I had ever seen one of their patients). I didn’t pay, and later found that the patients all kept the money. Many insurance companies sent me contracts I couldn’t afford to sign, and none of them responded to my requests to negotiate, or even allow patients I had already been seeing continue to see me after I could not accept a new contract with new restrictions. Over the years I could accept fewer and fewer plans, so emergency out of network care was uncompensated. Many patients wouldn’t even pay their co-pays. The hospital recruited uninsured patients, and received state funds for caring for a disproportionate share of the uninsured. Those of us on call just had to care for those patients without compensation. Most years I was the only orthopaedic surgeon willing to take call. It is a shame that I wasn’t sufficiently valued by many patients, insurers, and the hospital to justify even a small compensation for much of my work. Over the years reimbursements shrank, expenses grew, and requirements to provide uncompensated care increased. I don’t think it would now be possible to survive financially with a small single specialty urban practice like the one I had. Surgeons are increasingly pressured into being employees, or partners in large groups. The employers and insurance companies will continue to take unfair advantage of physicians, to the detriment of patient care. It would be foolish for physicians to expect sympathy or expect to be treated ethically.
This happened to a friend/colleague about 20 years ago. She was notified that the patient received the check for the care. She called and spoke to the wife. The wife told her we were having money problems and we prayed for a blessing. The money was sent to us as a blessing and you cannot go against the Lord’s will in asking for it back.
I would liken the insurance companies to the Lannisters. Backstabbing and Greedy. Out for their own interests. They bent the knee to Obamacare because it benefited then financially but screwed the patients. Much like the show. If we go Down with Socialized medicine my only condolence is Big INSURANCE and Big Pharmacy will burn with us.