mcbride
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Joined: 1/14/2005
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If only it was merely some sort of billing software issue.
Doctors in the US, particularly primary care doctors, spend hours every day, dealing with insurance companies that routinely deny patients' treatment, routinely and increasingly cut payments to doctors for services already performed, and increasingly require pre-authorization for even the most routine procedures.
That time spent by doctors (and patients, and many others) is one of the most important reasons why the United States spends far more per capita on health care than any comparable country. In fact, says Professor James Kahn, "the gap is so enormous that a recent University of California, San Francisco, study estimates that the United States would save over $161 billion every year in paperwork alone if it switched to a singlepayer system like Canada's."
It's also cited by doctors as one of the main reasons so many are getting out of primary care. One example: The Toledo Blade's online survey of members of the Ohio State Medical Association and the American Medical Association showed that "99 percent of the 920 respondents reported interference by insurers in their treatment of patients.
"The survey, which was sent by the associations to their members and included 700 Ohio respondents, questioned doctors and doctors' offices about interference from insurance companies, self-insurance funds, Medicare, Medicaid, and prescription drug plans. The survey showed:
• Ninety-five percent of respondents said insurers interfered with decisions about prescriptions, 91 percent with testing, 74 percent with referrals, and 69 percent with hospitalization decisions.
• Eighty-six percent said interference compromised patient care, 76 percent said it adversely affected their patients, and 65 percent said they were unable to successfully protest denials.
• Seventy percent noted they experience interference at least once a week, with 92 percent answering that interference increased during the past five years.
• Fourteen percent believed interference from an insurer had contributed to the death or serious injury of a patient."
The AARP Bulletin reports that "[Primary care doctors'] earnings on average are half or a third of those of doctors in many specialties, yet their workdays are longer and their overhead higher. Hours spent on paperwork and phone calls for prior authorizations demanded by insurance companies reduce the time spent with individual patients."
In a recent book that asked 12,000 doctors for their thoughts, physicians reported that "difficulty with managed care organizations" was the second most "unsatisfying" part of their job, second only to reimbursement issues, which, as we've seen, is the same issue.
Do have a look at the quotes in the book preview. They're quite eye-opening. Also see Doctors Shoulder Mounting Insurance Burdens by Joanne Silberner.
So, no, not really a question of finding billing software.
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I've seen a fair bit of coverage of that, ie, US doctors spending half their day on the phone trying to get permission from insurance companies for this or that treatment.
I wasn't aware that the doctors dealt with the insurance companies. I thought that was what the billing department was for.
I don't know about yours, but my family doctor doesn't have a billing department.
And yes, even in hospitals the doctors do deal directly with insurance companies.
I've mentioned this on here before, I had an accident that I was kept in the hospital for two days for observation. My insurance company refused to cover it saying that I should have been treated and released.
I spoke to three of the doctors who treated me and they all said it is a common occurrence for insurance companies to routinely deny claims.
All three contacted my insurance company and the claim was eventually approved.
Wow that really sucks. Maybe you should let your doctor know about the whole billing thing. I bet he would really love to get out from all that paperwork and start spending more time with patients. He could contact his local college. I bet they have programs for people to get their billing certificate and they could probably hook him up with someone.
Oh and you also might want to check with those 3 docs at the er. If they are handling this themselves, it could be a simple case of submitting the wrong codes. If they had hired someone to do the billing and coding, instead of trying to deal with the insurance companies themselves, you might not have had to wait as long for it to go through. That's why they have medical coding specialists, so the doctors don't have to worry about that crap and less errors get made.
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RE: Where is the compassion? - 
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