Home Forums Discussions General Discussion Turning tables against insurances

Many doctors feel Insurance industry is like a cartel.

Now turning the tables:

http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard-short.pdf

http://www.bizjournals.com/triad/stories/2008/06/16/daily16.html

Geeze... it's about time for goodness sake. Why did it take so long for these guys to wake-up and smell the coffee? They've only been asleep at the wheel for like 20-30 years while everything around them, but them has changed...

They still probably wouldn't support a National Union, and I still haven't heard anything like what Al and I propose about either we all get the same anti-trust waiver or we repeal theirs to at least somewhat level the field...

So much of what they do is just pure violations of any common sense interperation of anti-trust. Just the concept of in-network being different than out of network and limiting an end retail provider of services direct access to their own customers that they personally provider services for is so obviously anti-trust it makes my blood boil each and every time I think about it.

Now everybody repeat after me and Joe, Cartel, Cartel Cartel! Now doesn't that feel better really calling them what they are???

Good Night and Good Luck,
Paul

Good for the AMA!
Organized Medicine and the strength that standing together to advocate for physicians and patients brings is the only reasonable way to combat insurance company abuses. It is ironic that most physicians do not support the AMA by joining it.
Please check out AMA President Ron Davis' farewell speech from last weeks Annual AMA Conference.
http://www.ama-assn.org/ama/pub/category/18670.html
Three months ago Ron was on top of the world, a preventive medicine doctor doing a great job leading the AMA, the next day he was diagnosed with metastatic pancreatic cancer, but he still keeps advocating for patients. Very humbling.
Jim

What a moving speech!!! Thanks for the link.

Leslie

I took the night to chew on this. Now he sure sounds like a good man and goodness knows my heart goes out to him. And even his perspective on preventive care and the like is extremely admirable.

But I still don't see the AMA asking the high paid specialties to assist their struggling brothers and sisters in primary care by totally changing the fee schedules to one that value office visits and time intense management, as I put it, where the rubber meets the road, to just about double office visits. We still pay a specialist $2-3K to chop off some diabetic's leg but we can't pay a PCP even $100 a visit to manage and treat the same patient so he needs less medicine, eats better, gets off his lazy @$$, and save his leg in the first place.

Until I see the AMA put small offices and primary care front and center where it should have been all along they still won't get my vote. Until they stop support invasive and unconstitional concepts like centeralized national servers containing all of our health records that any and all, especially insurance carriers can access they have not earned my support. Until they stop playing ball in the enemies court, rink, pick your analogy, by their rules, with their bought and paid for officials, they still don't have my support.

Until they go on the record as demanding no other changes will even be considered, we ignore you, we spit on you our bought and paid for cops of the insurance industry, until any form of limiting patient access to any validly licensed provider with no more networks and no more prior auths that can only be done by co-opted hands tied PCP's they will not have my support. Patients today who would even choose to see an out of network doc still need a network doc just to get their meds, their tests, the visits to other docs approved and thru their papermill. That is totally unacceptable horseCCHIT and they have been MIA here. Still playing in their rink by their rules.

Until the demand either an end to the carriers anti-trust waiver or that we must all be granted the same exact waiver so as to be able to leverage back on a some what level playing field; and that our talking and sharing among ourselves can be as wide spread as any of them have any covered lives then they will not have my support.

The only way we are going to really win and not continue to go one step forward and then two steps back, it to finally demand and total shift in the rules and perspective. A non insurance first model, and healthcare, patient and provider first model which then drives creative thought for solutions, and brings to the forefront the arguement of why it is so important to fund these things.

How about one single law. No more for profit insurance carriers? All carrier must be truely Mutually Held with the Policy Holders being the voting share holders like in other mutual insurance companies and Credit Unions. And that furthermore, corporate officer compensation must be put to a vote of those shareholders no more than every 2 or 3 years???

How many of you practice this one single basic concept in your own life for your car and home owners insurance??? Your personal banking??? We do all around. Only our practice loan came from a private bank, M&T the we don't like and will hopefully one day run away from. Don't give the piggies access to your money and information for their own gain and to use against you. We are members of two credit unions and thru our credit union with have all our personal insurance thru Liberty Mutual. Heck I even bought our regular business policies thru Liberty's small business company, Peerless. I intentionally went out and sought them out for just these reasons.... You can make a big difference by voting with your "rights as an American Consumer". Take away the source of their power, our, your money that they then turn around and use against you.

Again this poor guy really does sound like a good and decent man. And goodness knows he has the fight of his life on his hands and he is facing it with amazing dignity and grace, even to report and heal the rif between patients and doctors. But that doesn't buy the AMA itself a free pass on their over charging their worse off brothers and sisters on their dues while the well heeled specialists that their failed policies have protected all these years pay the same exact dues. We don't pay these dues because it literally is not there in the budget to pay, neither is our state and county medical society dues either. And when a hard working doc who is providing real care to real patients under such an insane system that even just four years ago these @$$holes were defending and pumping up, to the point where she can't afford to fix her own home, buy a new car, pay down her debt, hire and retain good staff, or keep the lights on and pay her doubling malpractice insurance, feed and cloth her own kids, something is so wrong and out of whack that a savante could see the insanity in it, then these guys don't get a free pass from me. They don't have my vote and they won't until they finally get really radical and decide to stand, be counted and fight.

I totally agree with the main point of his speech that he hit on over and over again. Just what legacy do these out of touch old geezers care to leave behind??? Why does it take a life threatening illness to get in touch with the patients who have to navigate our dysfunctional system every day? Or to truely understand just how dysfunctional our system really is? As the parent of two school aged kids, who doctor wife went to the "other" residency program and so we have never had any inside connections to special treatment, as kids from the Bronx who had to wait an hour or two even 20 years ago at my HIP HMO center for anything, even a quick allergy shot visit, Nancy and I have always understood and related to our patients, we didn't need to be taught it. Perhaps some of these folks need to be mandated to watch that William Hurt movie "The Patient".

And so I wish the man the best of luck on the journey that is ahead of him, I really do. I can not even imagine what he and his family are going thru, and again his dignity and grace thru it all is inspiring and a model for us all. God's Speed. But that doesn't mean that any of us should think that they AMA finally gets it. It doens't mean we should be supporting those that don't support us down here in the trenches. It is time for something completely different and this organization resists change, it doesn't embrace it or facilitate it. Therefore, I support the man himself, but not the organization.

Can you accept and understand the difference??? Thanks for listening....

Mind if I provide another Evil Insurane Company Example? hey, i gotta vent!

Just got a denial on Wellpoint(Empire BCBS) on a in-office glucose monitoring (finger stick). The note says "Empire only provides benefits for this service when billed by the laboratory vendor. The member cannot be balance billed."

WTF?? They dont want you to bill for a "non-covered service". As if someone with out of control blood sugar has time to go to a Quest Service Center, or wait for labs to come back???

grrrrrrr. GRRRRRRRR! Hulk SMASH!

Next time have them pee in the cup and send them the code for the old Dip stick instead so they don't give you and your sis the old dip stick like this... lol

Are you sure about this? I mean this is such a standard in office procedure. How else is your sis supposed to know the patient's sugars to then take appropriate action. Send a copy to State AG Coumo. He seems to be on a mission to make the carriers's lives a bit difficult. It's about time too. And call your provider rep and drive them nuts on this. Hey why not deny Rapid Streps too. We'll just write antibiotics in the blind since they won't pay. This is a valid test to then lead to appropriate treatment. Don't let them off the hook.

Wayne, I've got to quickly run an errend and then I want to try and finally give you a buzz. Talk to you soon, OK??? If not have a great weekend.....

Paul

The standard fingerstick machines usually aren't reimbursed, but the "pro" versions (like hemocue) are reimbursed and have a different code. I don't know which ones besides hemocue that are considered "pro."

Of course they cost more.

Folks,

BTW: Any time anyone really wants to know how it is for the average hardworking frontline, small or solo practice PCP I just refer them to this great article.

http://www.merritthawkins.com/pdf/MHA2006SurveyofPrimaryCarePhysicians.pdf

What I love here most is that even back then two years ago 2/3's of all PCP's said if they had it to do over again, they wouldn't go into primary care. 2/3's! Half of those folks said that they wouldn't go into medicine again at all, would avoid it altogether, while the other half said they would have gone into a better paying and respected sub-specialty. Just amazing. But King Georege fiddles while Rome Burns and theatens a veto on any Medicare Fix.... Gotta love it, right?

Big write up in the NY Times as well as NPR seemed to get what little I caught of their coverage about it all fairly correctly especially in terms of PCP's already being pushed to the brink even before these insane cuts... Perhaps we are finally starting to get some traction.

Now I'm as sick at the smiley next to Bert's name on the new improved board...

Good Night and Good Luck, We'll Need it,
Paul