I heard that once at course. It kinda stuck. Like insurance co-pays, premiums and limitations.
The speaker went on to tell us an interesting story; a well-known dental insurance carrier had picked up and moved it offices from Santa Monica to San Francisco without notifying it’s subscribers or the dental practices rendering services to those subscribers. How many times have carriers answered queries about your bills with, “We never received the claim?”
Apparently, the speaker let us in on the little secret he learned while working for said company, insurance carriers spend a lot less money moving than paying their claims on time. Can you beat that? I think, twenty years later, I can.
To this day I still get that answer from my carriers. When they return my claims asking for information (documentation or radiographic films) I can’t help but fight back a little by encircling the left edge of the claim where the information had already been attached, and somehow was removed. I try and fight back further by stamping in red across the claim something to the tune of, “ The insurance commissioner will be notified if this claim is not paid within thirty days”. I’m not fooling anyone. Contacting the insurance commission once was like trying to become a contestant on “Who wants to be a millionaire.” NO ONE has that much time.
Now twenty years after that course I still keep his words of wisdom in my noggin. While I complained about a two-hour wait in a doctor’s office I had to take a step back and realize why it MIGHT be happening. It might be that the secretary is too inexperienced to know not to book seven patients right after lunch when the doctor only has three operatories. It might be that there was no where else to schedule emergency patients. It might be that the doctor, teaching at a University as well, only had limited office hours. But what it most likely was, what my boss was quick to figure out through my ranting, was HMO policy.
But I have a good policy! The negotiated rate is higher than others are! Everybody accepts it! I haven’t paid a thing! Okay, okay, okay…I may not be ‘deeper than a birdbath” (as one lovely TITTS poster likes to say) but my mind can follow a natural progression of thoughts.
My doctor’s practice, not unlike ANY other practice, is attempting to turn a profit under the constraints of managed care. My boss told me if I didn’t like the wait I should go out of network. But pay for something that can be free is not in my vocabulary…probably not in yours either.
We consumers demand integrity. We demand low costs and high quality. But if we continue to expect more for less the next step is socialized medicine. Then you really may get what you pay for and only the upper echelon tax bracketed patients will afford the best care.
In dentistry we’re lucky. We don’t have to accept HMO (known as DMO for us) as a constant big brother counting over our shoulders like the medical field does. But we have our share, as I stated above, of fighting with insurance companies for the PPO services we have rendered. What’s the answer?
In speaking to a wonderful medical practitioner, who I’ll call Trish because it’s her name, I asked if she was having any trouble with my claims being paid. She wasn’t sure but she was sure that managed care was so intrusive in her practice that she was seriously contemplating dropping plans that had become unaffordable. But she didn’t want to turn away patients.
Insurance companies count on that. They count on the integrity of the practitioner as well as the lack of integrity on the subscriber. What I mean by this is that insurance companies, like medical practices, are running a business. And not just for a hefty profit but, and I truly believe this, to outweigh expensive litigations.
I waited two hours because Joe Schmo is still collecting on a back injury from 1980. He wants to go back to work, his wife wants him out of the house, presumable back at work, but the insurance companies will pay Joe, with the proper documentation, to stay home. Indefinitely. And if not Joe, then Susie who was rear-ended two years ago. Or Claire who slipped in her neighbor’s driveway or in front of a local restaurant. And their excuse? They’ve all paid too much to insurance companies for too long not to feel that it’s now their turn to turn a profit. Please don’t badger me with e-mails about well-deserved claims, I know they’re out there and I humbly apologize to those good people, but it’s the undeserved claimants who do the bragging. Loudly and proudly.
Who’s the one lacking the integrity now?