Insurance company non-compensation for services

[Mike59]

Hi everyone,

I've heard time and again horror stories about how insurance companies play games with primary care physicians by either undercompensating the doctor for payments, delaying payments, or not paying at all in some cases.

For those in residency or in practice, can you please comment about the various ways of getting around this? Does it help to be in a larger group practice with more front office staff as opposed to a smaller independent-style practice? Is there any legislation on the schedule that may crack down on this type of "cheating"?

In spite of this, when they say an FP makes $120-150k, does this mean it could be significantly higher if the insurance companies weren't playing these games or is that number "predicted", based on the total number of patients seen (before compensation)?

Thanks a lot for your time!

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[Goober]

Understand this- Insurance companies main goal is to collect money from the people they are insuring and pay out as little as possible in order ro max their profits.

Basically there is no way around their games. They will find any reason they can not to pay. large group or small group makes no difference. You will have to devote considerable manpower to insurance billing either way. If one minor thing is not done right on the paper work, you won't get paid. Even if everything is done right, they will just underpay or not pay at all. You can easily spend hours and hours plus lots of money to track down a minor bill. Most docs collect about 50 cents on the dollar depending on what market you are in.

You can report insurance companies to the insurance comissioner or sue them, but that is a long painful process. They also constantly try to drop reimbursement rates. You cannot get together with other physicians to agree on a price because that is considered collusion and is illegal. I just read about a group of OBgyns in a certain city that got outraged when some major insurance company decided to make them sign an agreement that they could in effect change prices whenever they wanted and did not have to follow percentages of medicare which they normally do. So they all got together to fight this outrage. Guess what- the insurance company called the FTC and the obgyns were charged with collusion.

It's not just primary care docs that are affected all docs feel the pain of insurance companies. That is why plastics and derm are so popular- cash upfront for services rendered.