The state we find our healthcare system in is appalling and is getting worse every year. Instead of us all working together to make the system more efficient and less costly, we have battles between insurance companies, physicians, hospitals and, yes, our lawyer friends. Self-centered drives have put us into this position which we find ourselves in and no one, especially our government leaders, is really trying to make things better through cooperation. When President Obama held discussions regarding the new Affordable Care Act, now known as Obamacare, it was the same old partisan politics of Republicans defending insurance companies and Democrats steadfastly defending their lawyer friends and, consequently, we got a bill that no one is really sure of and, secondly, is full of handouts and politically correct nonsense. In addition we now see that it has tremendously increased the price of health insurance for the majority and limited access to coverage in many states. Why must I care for illegal aliens who do not pay for my services and yet have the ability to sue me? Could it be that politicians have some motivation to allow it to continue? Votes, my friends, it's all about votes to politicians. And our elected officials have their own expensive private health insurance that we pay for and is guaranteed to them for life. How many of our senior citizen politicians are on Medicare, which is supposedly their great gift to society? If it is so great for us, why isn't it good enough for them also? And yet who calls them on the carpet for all this? Americans need to wake up and start making politicians and insurance companies work for them instead of the other way around. A number years ago I wrote an article for the Asbury Park Press newspaper entitled “Dictated, Not Managed, Care.” In it, I outlined many of the schemes insurance companies use to delay and deny payments to physicians and limit healthcare benefits. You cannot have businessmen cram cookbook medicine down physician's throats; it just will not work. Can physicians be taught how to be more efficient and less costly in their practices? Absolutely but that is not the way to do it. And unless there is some benefit for the physician, what is the incentive to do so anyway? Do I want to jump through hoops so some greedy executive can take home another million dollars next year? Of course not, but no one seems to get the picture. It is going to take some education of physicians to change their ways of practice, but it's not going to come from an insurance company that alienates and dictates policy to its physicians. I have to go through an extensive credentialing process with each insurance company so that I may participate with them. And then I am treated like I don't know how to care for MY PATIENTS. They don’t know the patient’s situation better than I but the cookbook brand of medicine they are trying to get us to practice doesn’t work for everyone. We are tired of hearing about using this drug because it is cheaper than another which is more effective. Why should we be sending the patient home a day earlier without any documentation of benefits to the patient we are caring for. Until insurance companies change their philosophy of saving the “Almighty Buck”, physicians are not going to be convinced that their way is right for the patient. We have cared for patients for many years with tried-and-true guidelines and it is going to take some real convincing to change us. But again, no one seems to be trying. If my fees are constantly being cut, why should I care about adopting more cost-efficient policies? For profit insurance companies are in the business to make a profit and they don’t care about the patient. What’s more they should not have any say at all in how a patient is treated because they are not trained to deliver it. They want to dictate cost saving policies but not at my expense. Talk to me so we can sit down and work together to benefit both, but don’t dictate medical care to me. I’m the one who struggled through medical school which cost my parents a fortune. If I am told to send the patient home earlier, it is the physician who takes the risk, not the insurance company. I have seen so many patients get sent home early and the truth of the matter is they confuse going home with resuming normal activities. This leads to more complications or even deaths especially in surgical patients. I have had insurance executives that I have cared for when sent home early to comply with insurance companies guidelines that this is “barbaric”. Hello, these are your rules not mine. And ultimately, I get reimbursed less for theoretically being more efficient. Why should we sign on to that philosophy? We must learn to work together.
Several years ago insurance companies began to dictate how long a patient could stay in the hospital for a specific condition or procedure. That led to what became known as “Drive-by Medicine”. We were told that patients could only be in the hospital for 24 hours after giving birth, having a mastectomy or many other surgical procedures. First of all patients are all different and cannot be lumped together in one nice little grouping and treated the same. A nine year old patient having an appendectomy is quite different than a 70 year old. So when it came to a patient who literally was unable to go home, we had to contact the insurance company for an extension. Good luck, especially if it was on a weekend. Somehow they have the notion that people only get sick between nine and five Monday through Friday. When you were finally successful in being able to talk to someone, most of them were incapable of understanding what I was even talking about. On one occasion I asked the lady I was talking to how old she was and what her background was. She answered she was 18 and had just completed high school and a two-week training course in medical case management. I went bananas! This was laughable but very true. I wanted to throw the phone through a window I was so angry and insulted to have to deal with that nonsense. When she asked me to spell the complication I was talking to her about, I finally lost it and said this conversation is over and, unless I hear from a physician, my patient would be staying in the hospital. That is not the way we are going to get a better and more efficient health care system. Don’t insult me with this nonsense of yours.
The next issue that drives physician’s nuts is the delay and deny tactics used by insurance companies. They will let a physician's office know that they need more information to process a claim or that they did not receive the required information and would we please resubmit it. Have you ever had the pleasure of trying to get one of those problems solved? It is a nightmare, to say the least. Many people, unless they have had to deal with one of those problems, have no idea the time and frustration involved with solving those issues. Many of the people I employ spend inordinate amounts of time on the phone dealing with insurance company problems like this. I was once denied payment for a delivery I had done and was sent a form for more information. My office was not even given the benefit of a phone call just a letter do this. Usually that is handled by our billing department, but I happened to get involved in that one myself. I called the insurance company and was told the blanket statement they needed more information to process the claim and that they needed copies of the patient's records to review. I said to the individual I was talking to that I was not going to do that because it was unnecessary. The patient has paid good money for health insurance. I have been certified by you to deliver that care. The facts are she became pregnant, I took care of her and delivered her child, at 3 AM by the way, and I wanted to be paid. That's it, you don't require any more additional information. I also informed them that unless I received payment within the next week, I was going to report them to the state insurance commissioner. My billing manager was now staring at me in utter disbelief. However, I received a check within 48 hours. When dealing with insurance problems, especially denials, that is always a good line to give them because they are afraid of being fined by the insurance commissioner. But it points out that it is all a game they play to hang onto your money a little longer. When that is magnified by millions of accounts, you can see how profitable the tactic is for them to delay and deny. I also have been told of another delaying tactic by several patients of mine who work for insurance companies. At five o’clock on Friday supervisors come around and collect claims that have not been taken care of and throw them into the garbage can. So when your office gets a request to resubmit a claim that you have made that is probably the reason why. That was a phone call I did make to the Insurance Commissioner’s office.
I never thought that the following words would ever come out of my mouth, but I believe the only fair answer is a single payer national health insurance for everyone. It simplifies the whole process and everyone gets the care they need and deserve. If you don’t like it you can pay extra for more private or personalized care. This is partly behind what many physicians are now doing with something called Consiege Medicine. Most countries have some form of national health insurance except for the United States. While there are many flaws with this type of system at least everyone is covered which definitely needs to be the goal. While I dread the government running another health care system, like Medicaid or Medicare, many countries have made it work, some better than others. From what I have seen the French model seems to offer the most benefits for the provider and the patient. We cannot in good conscience let someone go bankrupt over medical bills or worse yet die for lack of coverage. The current battle between Democrats and Republicans is disgusting. A Republican or Democratic bill cannot and will not be fair to all. So why can’t they see this and come up with a joint plan that incorporates the best of both parties ideas? I have been to Washington to discuss health care with my congressman and the one thought I came away with is this guy just doesn’t have a clue. Unfortunately he and his colleagues are making the rules for Medicare but they are not in the system because we give them very expensive private health care for life. We have to stop coming up with plans that are only supported by one party. This will not work but it is all they seem to offer nowadays. Why can’t they work together to solve the problem? Are their egos that big that they can’t listen and work things out together? I still think the answer is to put a Democrat, a Republican, a doctor, an insurance executive, a lawyer and a private citizen in a room and don’t let them come out until they have an acceptable answer for all. President Trump said he can’t believe that health care is such a difficult problem. Well it isn’t if you remove the politics from it. I could go on much longer but I think the basic problems have been touched upon. Work together and stop the bickering. Amen!
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