Would a single-payer system prevent/resolve problems like this?
Would a single-payer system prevent/resolve problems like this?
http://www.ama-assn.org/ama/ama-wire/post/ruling-could-give-insurers-leeway-terminate-physicians?utm_source=BulletinHealthCare&utm_medium=email&utm_term=082915&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend
http://www.ama-assn.org/ama/ama-wire/post/ruling-could-give-insurers-leeway-terminate-physicians?utm_source=BulletinHealthCare&utm_medium=email&utm_term=082915&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend
http://www.ama-assn.org/ama/ama-wire/post/ruling-could-give-insurers-leeway-terminate-physicians?utm_source=BulletinHealthCare&utm_medium=email&utm_term=082915&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend
http://www.ama-assn.org/ama/ama-wire/post/ruling-could-give-insurers-leeway-terminate-physicians?utm_source=BulletinHealthCare&utm_medium=email&utm_term=082915&utm_content=physicians&utm_campaign=article_alert-morning_rounds_weekend
Makes it worse — then there's just a single entity deciding what is and isn't appropriate treatment, and it still isn't the doctor.
ReplyDeleteThe ability of insurance companies to determine what doctors you can go to.
ReplyDeleteBRAINSTORMING ...
There would still be constant debates over what gets paid for, how much gets paid for it, and whether or not it is medically necessary. Also, I would be curious to have a lawyer who specializes in this stuff explain it to me, because I was very much under the impression that patients were on the line for payment if insurance refused.
I don't know the specifics of how/why/when you'd sue the insurance company versus the patient. I am aware that it is a many decades long practice of insurance to dispute what they said they'd pay for.
The difference here, I think(?), is that this is an insurance company paying for something then demanding the money back after they've paid and using the threat of removing you from their list of covered physicians if you don't give the money back.
One possible problem with this is that there are fewer and fewer (health) insurance companies. If one of them pulls you off their roster, it can mean no one with that insurance anywhere in the country can see you unless they pay out of pocket. That may affect whether or not you can get privileges at a hospital that works with that insurance; or whether a practice would want to hire you, if the rest of the group can take that insurance. At the very least, it complicates things for the physician trying to practice, as well as the patients needing care. My impression right now is that this happens regularly but not enough to have a large impact.
It's also a lousy business model if you have to worry that every time you provide a service and get paid for it, someone can come back some unspecified period of time later and say, haha, nope, give me my money back. Not because you failed to provide the service contracted for, not because you did a poor job of it, but because they changed their mind after the fact about what they wanted to pay for.
Would only dealing with the government fix this? Well, they could still threaten to not allow anyone to see you unless they pay out of pocket, although if we decide that healthcare is a right then they kind of can't because, and I'm pretty sure it's harder to argue with the government if they decide they want their money back, because then it's a potential felony against Medicare (there are specifics there, but it's possible). However, the insurance companies profit motives would be beside the point, because the government would have negotiated and set the rates and rules and it would be one set of rules to deal with and the insurance companies would only be able to argue with the government, not try to isolate and bully individual doctors or practices.
The whole thing is kind of a morass.