I don’t know of one doctor or hospital that is not writing off balances of what the insurance companies are not paying.  On top of that it is one administrative nightmare, medical assistants can’t get the time in the consultation rooms with the doctors as they are tied up on administrative functions, see it all the time.

If you want to see more detail and missed it last year, go watch Sicko.  Whether or not you like Michael Moore or not, the stories told about the insurance claims do a pretty good job of documenting what is happening, initial approval, then after the procedure, cherry picked for a minor item that was maybe left out and “claim denied”.  I watch some doctors get on the phone and “scream” with insurers to get matters taken care, and sometimes it works. 

I can’t think of one practice I have visited of late that has not had the same complaint.  It is one big administrative nightmare.  If you are the patient trying to take care of your health, well we know what that is all about, more financial stress over trying to do the right thing, but yet the insurers want us to take better care of ourselves?  Catch 22? 

What happens if the physician opens a concierge practice, the insurers drop them.  The California Department of Managed Care has made some forward efforts, but you wonder if they might cower a bit under the auspices of the well funded legal teams maintained by the insurers and need a little help, as they fines get paid and then it’s back to business as usual with perhaps a couple administrative changes, but small compared to the overall picture.  With all the cash reserves that the insurers have, the fines are a small price to pay, and added up all over the US with carriers combined, the numbers are in the billions.  Until we get out of the emphasis on risk management and can focus on healthcare, the picture is probably not going to change anytime soon.  We all know the the insurance payers are not interested in our health, but rather the money side of things and if some folks get well in the process, then it can be viewed as a positive in some areas, but the overall picture is still pretty ugly.  Hospitals are feeling it too and you can read about several of them across the country under a series I did called “Desperate Hospitals”.  BD   

Insurers have found a very creative way of denying, delaying or slowing payments in a way that is having a real impact on patient care and some of our survival," said Von Crockett, Centinela's chief executive. "Every single doctor and hospital is writing off money they are legally owed but don't collect. It's an insane situation.

Collecting that money would have given Centinela a measure of relief. But the bills went unpaid, and the century-old medical center was sold. The new owners slashed services, closed half the operating rooms and laid off a third of the employees.
Who owed Centinela that elusive $25 million? According to hospital officials, it was health insurance companies.

As a result, doctors and hospitals have little negotiating power and few options when an insurer rejects a bill. Some physicians are dropping out of insurance networks or turning away new patients. Others have moved to cash-only practices. Some smaller hospitals and solo-practice physicians say they are being driven out of business entirely.

Dotti Smith, office manager for a group of surgeons affiliated with St. Mary's Hospital in Long Beach, recently billed a major insurance company for a gallbladder operation. The insurer had preauthorized the surgery and the surgeon was a member of the insurer's network of preferred physicians, Smith said. But the company refused to pay the $3,100 bill.
Why? The patient was enrolled in a subcategory of coverage with a smaller network of doctors that did not include the Long Beach surgeon.
The surgeon's office contacted the patient, who replied that the bill should be her insurer's responsibility.

Last fall, Dr. Michael Hurwitz, a general surgeon at Hoag Memorial Hospital Presbyterian in Newport Beach, dropped out of Anthem Blue Cross of California, a WellPoint subsidiary, after the insurer reduced reimbursements for his procedures by 30%. If he treats a Blue Cross patient at the hospital, he bills the patient directly.

Related Reading: 

Centinela Hospital's cuts create anxiety in South L.A.

Patients caught in Centinela Hospital Medical Center's shake-up

Centinela hospital is bought by Prime HealthCare – California

Hospital expected to seek bankruptcy protection - Los Angeles

"Michael Moore, you just saved my home."

The battle of the medical bills - Los Angeles Times


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