Sometimes the ER doctors and hospitals have different contracts and this is beginning to be an issue in Texas as it ends up with patients getting sometimes huge unexpected bills.  I had to laugh when I saw a “dead” doctor listed at I thought Healthgrades and Vitals were the kings of dead doctor listings but look like insurers leave in them in network for some amount of time.

Healthgrades Partners With Athena Health To Provide Easier Access to Book Appointments, Like Maybe Doing Better With Sorting Out Some of the “Dead doctors” Seeing Patients in the After Life?

At some point this has to change as consumers can’t continue to work with this and keep shifting and know when every tiny change is made, it’s too much anymore based on contracts that change at the drop of a a business intelligence algorithm.  That’s what’s going on.  At United we have the “secret scoring” where they are being fired and given no reason why, so you know it’s an algorithm making that decision.

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

Oh and they all cite the patients who can’t the right information, even though websites are not fully updated an so on, it’s always the patients fault.  Here in California the CMA is also up in arms with United, heck they are using as they stated a model to grade doctors that’s been in use since 2005.  I found it funny they said that as models don’t last that long and continue to work for that many years in healthcare or finance for that matter, ask a hedge fund quant.

United “Quantitated” California Doctor Premium Designation Ratings For Consumers, A Few Minor Changes-CMA Still of Opinion Ratings Cause Harm to MDs and Patients With Inaccurate Designations and Flaws…

Here’s a link from a short while back where United is shuffling patients around and firing doctors, trying to match patients up with other primary doctors but their algorithms are not doing too well as Medicare Advantage folks found themselves getting letters referring them to an OBGN and a neurosurgeon as their new family practice doctors. 

Patients In Tennessee Speak Out About United Healthcare Firing Their Doctors As the Effort Continues To Reduce Their Own In House Overhead With Managing Fewer Doctor NPI Accounts, Contracts and Billing…More Killer Algorithms At Work Hurting Seniors

Patients are not only over whelmed in Texas but all over the US and again this has to stop with optimization of networks and the AAFP recently wrote to insurers about this topic as well.  Doctors and patients are people and they can’t jump and run when algorithm comes calling.  This is exactly what’s happening and the insurers business models themselves are failing if they can’t do better data matches and bring the human elements into the picture.  This is not the patients fault as insurers and many have said this besides me, thrive on complexities as it means profit so there’s no incentive for them to really stop it either. 

AAFP Says We’re Not Going To Take It Anymore With Optimization of Provider Networks - Specifically United Healthcare’s Doctor Dumping That Disrupts Continuity of Care

Trey Berndt, an associate state director for advocacy with AARP, told lawmakers emergency-room visits present special challenges for price transparency because hospitals sometimes contract with emergency-room doctors who do not participate in the same insurance plans as the hospital. A website listing which hospitals have in-network doctors in their emergency rooms is not going to help a patient undergoing a stroke, he said.

“The transparency stuff does not work in an emergency situation. You don't have time," said Berndt, whose organization advocates for people of retirement age.

The report found that in emergency rooms at roughly half of in-network hospitals for United Healthcare and Humana, two of the state’s three largest insurers, there were no in-network physicians.

Lawmakers also considered the transparency issue outside of emergency rooms. State Sen. Leticia Van de Putte, D-San Antonio, called on insurers to regularly update their lists of in-network doctors. She cited an example of a dead doctor who was still listed on one insurer's network. She also said the state's current transparency requirements — including a rule that insurers give written notice to patients who could face higher costs from out-of-network providers — are insufficient.

Charles Bailey, representing the Texas Hospital Association, said consumers were often overwhelmed by how complicated the health care system can be, but that “hospitals are doing their best to help educate” them. He acknowledged it was a problem that hospitals are “not always able” to employ in-network physicians.


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