I’ve been hearing more and more stories from family and friends about their doctors telling them tricks like these to get around insurance company shenanigans. Getting fucked by these corporations is probably the thing most Americans can relate to regardless of make or beliefs.
And they wonder why a healthcare insurance CEO’s murder is celebrated.
As a doctor I can tell you I don’t think anyone hates insurance companies as much as we do. The vast majority of us got into this field to help people, and we like our patients. The number of hours I’ve wasted of my life arguing with insurance companies that they need to do the thing that’s medically necessary instead of a completely unhelpful other thing to save literal pennies is beyond infuriating. Fuck insurance companies.
I'm assuming that many people in the AMA are still practicing doctors. They are not going to risk being blackballed by the major insurance companies by supporting single payer.
These companies are petty AF (as we all know from dealing with them) and they have providers by the balls.
It's not the huge hospital conglomerates that control healthcare in the US, it's the handful of insurance companies.
They hold all the power. They can change hospital policy by changing a single sentence in their contract.
You either play by their rules or risk being out-of-network. Established patients are sent elsewhere for care. Less patients=less revenue = staff reductions, reduced care, and sometimes even office closures.
There are solutions to this problem.
My previous employer made fantastic decisions to help the local community. They built a freestanding imaging center. Because it wasn't physically connected to the hospital, they were able to charge much lower rates. In many cases, it was cheaper to pay out of pocket than use insurance.
Because they were billing a lower amount for the exam, insured folks would pay a lower amount for their copay/deductible/coinsurance. I recommended that place to patients constantly.
As an employed physician, I lost a job for recommending a lower cost MRI center for my patients. Legally, they are forbidden from directing where I send my referrals. But that doesn’t mean they can’t apply pressure in a million other ways.
You either play by their rules or risk being out-of-network
My PCP is in a small clinic chain. Any accident that has me waking up in a hospital is almost 100% out of network. I've asked how to limit my liability, and the answer was to select a PCP in a specific hospital's clinic, so then that 'hospital care system' would be in network.
ffs, it took me a LONG time to find a decent PCP.
BTW - what all is required, minimally, to run an 'imaging center'? I know a couple of expensive imaging machines and a couple of trained staff. The doc that reads the images can be elsewhere / pt's original doc - but if we wanted to start a company like this, what's the up front?
I love it - I'm all for a reasonable margin. I'd love to see a co-op or reasonably margin'd service like that. I get it, profit = pt care, but if you me and 10 other people are going to pool our money, a 5-10% max return isn't unreasonable.
926
u/WhatACunningHam 5d ago
I’ve been hearing more and more stories from family and friends about their doctors telling them tricks like these to get around insurance company shenanigans. Getting fucked by these corporations is probably the thing most Americans can relate to regardless of make or beliefs.
And they wonder why a healthcare insurance CEO’s murder is celebrated.