Medical Insurance

 

As a benefit to patients, I accept most medical insurance including UHC, Humana, BCBS, Aetna, and Cigna.  I also accept Medicare. This means that I file claims with these companies and that I accept their fee schedules.

 

But I don’t work for the insurance companies, I don’t work for a hospital system, and I don’t work for any institution.  I work only for patients who engage me to help with their medical needs.  I consider it to be a conflict of interests to work for an institution.  I can serve only one master.  Corporate Boards are concerned primarily with profits, and my concern is to provide quality medical care.

 

You may consider your insurance company to be your friend and ally.  This is false.  I consider medical insurance companies to be no better than legalized criminal organizations.  They will collect your insurance premiums, but if you need medical care, often they will make every possible attempt to avoid paying for the care that you need.

 

One of the most onerous strategies used by insurance companies is the requirement for preauthorization for certain tests and services.  This requirement is included in their contracts, but I generally refuse to comply.  The insurance company wishes only to discourage and delay your care, and the requirement interferes with my ability to provide quality care.  It can easily take 30 minutes of my time to educate an insurance company representative about the need for a test or service before receiving approval.

 

How can you trust an insurance representative to know more about your medical needs than an experienced specialist who has talked with you and examined you?  Furthermore, the insurance adjuster is incentivized to delay or deny your needed care.  That’s how his company increases profits.

 

I will not allow an untrained insurance adjuster with an adverse incentive to dictate your treatment.  I will not waste my time communicating with these individuals.

 

The Medicare Advantage (Medicare replacement) policies have been the worst offenders.  For these policies, Medicare pays a fixed amount to the insurance carrier and the carrier assumes responsibility for the medical expenses.  Because the insurance companies can’t increase the amount that they receive from Medicare, profit is increased only by denying or limiting the payments for service.  By replacing regular Medicare with “Medicare Advantage”, patients lose the ability for their physicians to offer care that they have determined you need.  Patients may also sacrifice access to the physician or hospital of their choice.