Reimbursement troubles, concierge practices, fixing U.S. health care
I enjoyed reading Helen Lippman's article "How to get paid" [August 15, 2008]. I was having difficulty with three claims from United Healthcare. After exhausting all my known resources with UHC, I decided it was time to write my state insurance commissioner, as recommended in the article.
After a month of waiting, I received a Provider Issue Return Form, of which there were seven different explanations why they can't help you. Mine was checked by the statement "The Colorado Division of Insurance cannot intercede in any type of managed care contract dispute under CRS 10-16-121(4). Contracted providers should utilize the carrier's dispute resolution procedures required by CRS 10-16-705(13) and 10-16-121(4) and outlined in Insurance Regulation 4-2-23."
Maybe the Division of Insurance is more provider-friendly in other states, but not in Colorado.
JAMES A. ZIMMER, DO
Colorado Springs, Colorado
SETTLING FOR 95 PERCENT
How sad is it that an article on tactics for fighting back against third-party payers uses "95 percent of Medicare" as an example of a win in negotiations with a private insurer. Unfortunately, when others bring down the lowest common denominator like this, it only serves to make it much harder for those of us who want to fight back.
CARY DOUGLASS, MD
BARACKING THE VOTE
Since your presidential poll results were so overwhelmingly in Barack Obama's favor, it would be interesting to know what factor most influenced voters to make their choice [Web Poll, October 17, 2008]. It's surprising to know that the audience of Medical Economics leans toward more governmental tax controls that would "treat everyone fairly and spread the wealth," instead of a more capitalistic approach.
THERE IS SOMETHING ELSE
Is it ethical for a physician to keep a patient waiting for two hours, only to rush through an appointment in seven minutes, scared to ask the question "Is there anything else?" ["How to set up a concierge practice," August 22, 2003; find it at http://www.memag.com/concierge].
My husband, a primary care doctor, decreased his salary $10,000 per year in a traditional practice as patient volume increased and practice overhead spiraled out of control. When he left traditional primary care, he was making $80,000 a year with $200,000 in medical school debt.
Concierge medicine offers an option to doctors who face the decision of leaving medicine completely. Many such practices charge $60-$100 per month and charge nothing more to the patient, and opt out of insurance. Often, patients go to high-deductible insurance plans, actually save money, and have better medical care. Most concierge doctors make the average primary care income, but are doing it with happier patients. I advise patients to give up the $4-per-day latte and invest in quality health care. Run, don't walk, to a doctor willing and able to ask . . . "Is there anything else?"
Charleston, South Carolina