Insurance administrative burdens both patients and their doctors according to the NY Times.

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Behind the scenes in doctors' offices.

Having been in practice for nearly 40 years, the administrative burden placed on doctors' offices is crazy.  Primary doctors juggle prescriptions, notes, records, and referrals for patients. Of course, there is coding, billing, answering phones, and scheduling patients so they can see the doctor and have their problems evaluated and treated correctly. In our chiropractic office, we verify insurance coverage, input patient information, make sure the patient knows how to find our offices, check if a referral is online when their other doctor said it was and prepare a file so things go smoothly the first visit.   Patients are shown where our patient history forms are on the website so they can have it all filled out when they meet us the first time. There is note taking which is about the patient and their consistency of care, billing, and all the usual things all doctors do. As with many doctors, our notes have been used as a tool by insurance companies to withhold payments if they are not perfect, something that is more of a game than something even remotely part of a patient's care. Insurers have upped the administrative burden on all doctors due to denying clean claims, retracting payments sometimes two years later due to a computer algorithm, or denying care that was clearly medically necessary and a referral was already on file for the patient. Their tiered networks as Governor Christie presided over have been inflationary, while higher quality practitioners without the size or clout of the large systems found themselves as tier 2.  This type of activity wastes money by guiding patients to higher-cost care and offering patients less choice of providers. In the second year of Omnia, those in the gold plan saw increases of up to 25% in their premiums. Is it any wonder why so many doctors have given up private practice and begun working for the large hospital systems or the private equity-owned clinics that have added largely to healthcare inflation? Apparently, this is a problem in veterinary medicine and dentistry as well. The problem is worse every year. All this unpaid labor is driving healthcare costs for doctors and costing patients as well while resulting in poorer care at the hands of conveyor belt medicine. Sit in an Emergency room for hours without being seen and you will see the problem first hand; understaffing is dangerous to our health but all the administrative burden is money wasted that could have gone to properly staffing an office.

Behind the scenes in patients' minds and pocketbooks.

Patients are more unnerved than ever as they try to understand that high deductible plans mean that you are uninsured until their out-of-pocket deductible is met.   Even still, if you do not have the right referral, bills from your doctor will be rejected resulting in bills and collection agency letters. Some hospitals have even gone as far as to take patients to court over these matters. Your referral may not mean much if the insurer who has ignored those online requests denied them before.  We recently had a patient whose Aetna HMO required a referral for each visit and then did not pay the bills with the referral online.  Our staff had to call the insurer to get them to reprocess it multiple times. A patient in pain must be able to access care in an unobstructed way and be certain those bills are paid.  Patients should get the care they or their company paid for.

The solution is simple.

Of course, the simplest solution is for the expansion of Medicare which would offer lower deductibles, universal coverage, and simplify everything.  One fee schedule, multistate coverage, and one set of rules. Recently, the NY Times looked into the problem that exists because insurers make money from the complexity and know doctors and patients cannot afford to fight it all. The result is that many doctors have left private practice and now work for systems that offer conveyor belt medicine while the system oversees the complexities. This has consolidated healthcare, left consumers with fewer choices and the systems charge more for those same services affecting our pocketbooks. Check out the article below

The Overlooked Reason Our Health Care System Crushes Patients

July 20, 2023 By Chavi Karkowsky Dr. Karkowsky is a maternal-fetal medicine physician in New York City. Sign up for the Opinion Today newsletter Get expert analysis of the news and a guide to the big ideas shaping the world every weekday morning. Get it sent to your inbox. Several years ago, I was called urgently to our small obstetric triage unit because a pregnant patient was very sick. At the beginning of her third trimester, she had come in with back pain and a 103-degree fever. Her heart was racing, her blood pressure was dangerously low, and her oxygen levels were barely normal. In sentences broken by gasps for air, she told us her belly was tightening every few minutes — painful contractions, three months before their time. Our team was concerned about pyelonephritis, a kidney infection that can develop from a urinary tract infection and can progress quickly to sepsis or even septic shock. Within minutes, a team was swarming the triage bay — providing oxygen, applying the fetal heart rate and contraction monitor, placing IVs. I called the neonatal intensive care unit, in case labor progressed, to prepare for a very preterm baby. In under an hour, we had over a dozen people, part of a powerful medical system, working to get her everything she might need. Read more