Profit-hungry health insurance companies are not just screwing their policyholders, they're also screwing health care providers.
Aside from the tremendous administrative costs that most doctors have to incur to make insurance companies live up to their contracts, doctors also have to deal with ever-shrinking reimbursements for services.
A group of specialist doctors in Ventura County, Calif., have had enough, and are telling Blue Cross, the largest insurance company they have to deal with (about 30 percent of the market), to go pound sand.
That is, they are dropping out of the Blue Cross network because of a new reimbursement schedule that is, for some, even less than Medicare's.
Details below.
First, have a quote:
"You get to the point where economically, it doesn't make sense any more," said cardiologist Jeff Brackett, referring to costs of staff, rent and other overhead that rise as insurance payments fall.
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"The patients are caught in the middle," he said.
Yeah, patients don't like this much.
(Retired aerospace engineer Jack) Woessner thinks he'd be forced to find a different urologist.
"I don't think anybody wants to do that," he said. "If you run your finger down the Yellow Pages, what are your chances of knowing whether or not the doctor where your finger stops is a good medical provider?"
Blue Cross has proposed cutting payments to specialists, who patients need when they have a serious or chronic health care problem.
The reimbursement cut is more than 30 percent for some practices, to a level below the Medicare rate.
According to the Ventura County Star article, more than 20 specialists in medical groups or independent practices have formally notified that they are dropping out.
A Blue Cross flack argues that they will increase reimbursements to primary care doctors while cutting the specialists big-time.
One primary care doctor doesn't buy the PR:
As a family practice doctor in Ventura, Ted Hole is a primary care provider.
He said some of his reimbursements will rise under the new Blue Cross fee schedule, but the payments still aren't enough to sustain his business, and he has to battle over authorizations of everything from medicines to X-rays. He's considering terminating his contract.
"It just gets to the point where you wonder why you went to medical school," he said.
Specialists have their own story to tell:
"After 33 years, I make less than half of what I did then for a prostate operation," said Cedric Emery of Ventura, who has sent a termination notice to Blue Cross and is considering doing the same with at least one other insurance provider. "I'm a third-generation surgeon, and I wouldn't think of encouraging my children to go into medicine because I don't want them to be unhappy."
And who would want to be under the knife of an unhappy surgeon.
Of course, the insurance companies' relentless drive for higher profits and million-dollar executive salaries affects the care that patients receive:
Quality of care is compromised too, doctors contend. Because they get paid less, they have to see more patients and spend less time with them. They complain that insurance companies are gaining too much power over the kind of treatments a patient receives.
Here's what two other doctors have to say:
"We've never, never quit any insurance programs in the 18 years we've been here," said Dr. Lamar Bushnell of the California Cardiac Surgeons group in Ventura. He offered another explanation for why Blue Cross is reducing some of its rates:
"Because they can," he said.
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"This is going to be a big disruption," said Dr. F. Ray Nickel of Ventura Orthopedics Medical Group. That group of orthopedic surgeons sent termination notices to both Blue Shield and Blue Cross and is now in negotiations with the latter company.
"We've been having this discussion for years now," Nickel said. "Finally this year we've said enough is enough."
For decades, doctors and their influential lobby have opposed national health insurance.
My guess is that many of them don't anymore, and that they'd like to see for-profit health insurance companies go the way of buggy-whip factories.