Viewpoint: Insurance intermediaries are bad for business

July 25, 2012

Medical Economics readers discuss the need to return to patients filing their own insurance claims, recertification being little more than a cash grab, and referral rates.

Insurance intermediaries are bad for business

I agree with Craig M. Wax, DO's column "Free-market, posted prices prevent sticker shock" ([From the Board], June 10 issue).

Unlike Dr. Wax, however, we do not offer a discount to uninsured patients who pay with cash in our office for our evaluation and management services. Many of these patients have elected not to purchase health insurance, while many other people (myself included) are responsible enough in their finances to budget and pay for health insurance, which typically costs several hundred dollars a month.

If a patient is unable to get insurance or can't afford to pay for services, he or she can take advantage of the various safety nets that are in place in our area. I certainly do not receive a discount for prompt, responsible payments to my vendors, utility companies, or landlord.

Our typical insurance write-off is 45% to 50%. As Dr. Wax pointed out in his opinion piece, insurance should be between the patient and his or her insurance company. Our payments should not depend on some nebulous, negotiated (for large groups...we, as a small group, are told to take it or leave it) corporate fee schedule. Imagine if a patient tried this line of reasoning with the body shop after wrecking a car.

We have really thrown the baby out with the bathwater by filing insurance claims for patients. I would love to return to the time when patients actually paid their doctor bills at the time of service, filed their own claims, and then waited on whatever reimbursement they were due from the insurance company.

Get rid of the insurance intermediary, and I believe you would see massive price reductions. I know I would lower my fees if we were always paid at the time of service.

MICHAEL S. JACKSON, MD
Rome, Georgia

Recertification nothing more than a money grab

I would like to make a correction to the letter "Recertification adds little value to my work" written by Dennis R. Burke, MD ([Talk Back], May 25 issue). The American Board of Family Medicine (ABFM) was established in 1969-1970. I am a charter diplomat and charter fellow in the ABFM.

I am one of 66 physicians who have recertified six times with the ABFM. I am in total agreement with Dr. Burke as far as the point he makes that recertification is of no special value. Most of the specialists do not have to take a recertification test, and that does not necessarily mean that they are not as smart.

The cost of being recertified in 2012-2013 is $1,700, which was reported to me by the ABFM. This cost does not include transportation, lodging, meals, and time out of the office.

It appears that this recertification business is just a money-maker for the ABFM, and if someone could show me otherwise, I would welcome that information.

ROBERT SCHIAVONE, MD
Louisville, Kentucky

The link to referral rates

With many primary care offices and specialists using nurse practitioners and physician assistants, I wonder whether the Archives of Internal Medicine study you wrote about looked for links between the increase in referrals and increased use of these midlevel providers ("In 'troubling' trend, patient referrals skyrocket," by Morgan Lewis Jr., [Medical Economics eConsult], January 25 issue).

Surprisingly, there also is no mention of whether the fear of malpractice also has increased referral rates in an effort to "cover your butt."

CAROLYN TRAN, MD
Jacksonville, Florida

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