Prior Authorization
The Insurance Company had decided that certain tests and treatments require “prior authorization”. Seeking prior approval consumes inordinate amounts of the doctor’s time, which is not compensated. Because of this uncompensated time, the doctor may avoid seeking “prior authorizations”, thereby avoiding the best treatment or best medication, device or procedure. In fact, the doctor would rather walk on a bed of hot coals rather than hang on the phone with clerks seeking “prior authorization”. To secure approvals, the doctor may be forced to exaggerate the urgency of the medical condition or use creative medical coding.
Fee Pressures from the Insurance Company
The health insurance company does not pay ordinary and customary doctor’s fees. Instead, the health insurance company creates their own fee schedule, paying a fraction of the usual fees. The physician has the choice of either accepting this paltry fee schedule, or opt out of the insurance system. If the doctors accept the insurance fee schedule, they are faced with financial ruin, as the resulting income is insufficient to support a medical office.
Cut the Fees, and Increase the Volume
If the physician accepts the insurance company skimpy fee schedule, the physician is faced with shrinking income. The only remedy is to cut patient services by increasing volume to 60 patients a day, and by so doing, profoundly change the quality and level of the practice of medicine. Seeing sixty patients per day allows only 5-10 minutes per patient, making impossible a true health care encounter. Can a physician deliver ethically responsible health care in 5-10 minutes ? I don’t think so. You try it and let me know..
The result has been a lower quality of medical care, increasing malpractice litigation, a loss of confidence in the medical profession, a loss of physician self-esteem, and an unbearable economic burden on our nation.
Corporate Corruption of the Government
The exorbitant profits gleaned from denial of care to sick patients are put to good use by the health insurance industry. The money is used to purchase the loyalty of the United States Congress, which then creates new legislation and new regulations favorable to the health insurance industry.
Prohibit Collective Bargaining by Physicians
For example, the health insurance lobby has secured federal legislation that prohibits physicians from forming unions to negotiate their fees with the insurance industry. This collective bargaining would have given the doctors the ability to negotiate from strength. Instead, doctors find themselves isolated, divided and powerless against large insurance companies on an unequal playing field.
Part D Medicare
Another example of this corruption is the Part D medication benefit under Medicare. This legislation prohibits Medicare from negotiating prices with the drug industry, making sure the drug industry rakes in windfall profits on medications sold through Medicare.
Massive Political Contributions
Virtually every health insurance company hires lobbyists in Congress. The health insurance industry is the largest political contributor, making frequent and massive political contributions to members of Congress. Although this practice corrupts our democratic process, it is currently legal. This is one reason we have not had a truly representative government in decades. Political payoffs from corporate special interests represent high corruption of government, and trades money for political influence and favorable legislation. We need reform in government which means public financing of elections and a ban on special interest money.
Professional Lobbyists
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