My Least Favorite Part Of Practicing…….?

Easy, dealing with insurance companies, their policies, their processes etc.  Sure, they reduce payments for services too, but that’s not even close to the worst part of dealing with them.  Insurance companies make their money “in the middle” of the doctor patient relationship, and not just the financial aspect of the relationship.  

I had to make a tough decision last year, whether to continue to be a provider for one of the major national vision care plans.  I chose not to continue, knowing that I would definitely lose some patients because of the decision.  But I simply couldn’t continue to do business with them.  Their payments for services and products weren’t any better or worse than the other vision care program (VSP) that I continue to be a provide for.  But their policies and marketing to my patients were just not something that I could continue to deal with.  You see, this particular vision care plan is owned by the largest commercial optometric organization in the United States, Luxottica, who in turn owns LensCrafters, Pearle vision and several other companies.

This vision care plan does not have the ability to integrate with the software that my office staff uses (or with any other eye care practice software), requiring my staff to manually perform many processes, from looking up patient benefits to filing claims and orders and pricing optical orders.  This not only took up too much of my staff’s time, it also confused patients and wasted patient time waiting for information before, during and after their appointments.

This plan also would market to my patients, directing them to their own offices and optical sales locations.  So, besides being “not easy” to do business with, they were competing directly with me for MY patients.

I’ve also had to deal with medical insurance companies and their lies to patients when selling them coverage.  We’ve had a group of patients purchase/sign up for a “Medicare Advantage” plan who were told that “nothing will change” with regards to your doctor choices.  Sounds familiar, ‘eh?  But I digress.  Well, as I write this, I am not a provider for this plan, meaning that patients who saw me early this year assuming that they didn’t have to change anything, racked up bills in my office that their insurance company wouldn’t pay.  We don’t have the contract with the insurance company, the patients do.  Meaning that technically, the patients were responsible for these bills.  I chose to write off these charges and not collect the total amount from the patients, meaning that I got to work for nothing, and pay my staff to work at the same time.  We’re looking into being added to this plan’s panel, and if they will pay a reasonable amount for procedures provided, I’ll hopefully soon be a provider for this plan.

Can you see why doctors aren’t enamored with the business side of health care?  And this isn’t an ObamaCare issue, this is and has been “par for the course” activities in health care for a long time.  ObamaCare will just intensify the issues, potentially driving more and more doctors out of the “insurance business” when it comes to providing health care.

Dr. Warren

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