Can doctors ever work together with insurance companies?

Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there is a reason why doctors’ signatures are so illegible). But then, something unexpected caught my eye: Right there, in a stack of neatly arrayed faxes and envelopes, were four insurance company approval letters in a row.

For anybody who has spent hours writing letters of appeal to insurance companies, and even more time on the phone waiting for that infamous peer to peer review, you know what I am talking about. But just in case, let me translate: A medication, infusion, MRI, or cat scan I ordered for my patient was approved without objection, qualification, or condition. In my experience, outcomes like this have become rarer and rarer, leaving me to wonder what’s crazier, the fact that this happened, or that it is so noteworthy.

Let me go on record by saying that I truly, sincerely, and unabashedly love being a doctor. Even at its toughest, there are crystal clear moments of joy and triumph and gratitude for the simple act of healing. Yet there are decidedly days where I find myself sounding off at the water cooler about the frustrations of dealing with so much insurance paperwork. According to the Department of Labor, one out of every seven claims is initially denied. For us, that means going back over codes, placing phone calls, and ultimately resubmitting these claims, often on a wing and a prayer.

So where did it all go wrong? A few months ago, I read an editorial by another MD who, in referring to the moments when patients would get upset with him when tests and medications were not approved, wrote, “This is not what I went to medical school for.” Sardonic tone aside, he had a good point.

In medical school, we versed ourselves in path and biochemistry and gross anatomy, but there were no courses on how to “get your medications approved,” or “how to talk to insurance companies,” or maybe even “how to beat the system.” Instead, we were drilled the algorithms for treating community-acquired pneumonia, acute coronary syndrome, and neutropenic fever and hyponatremia. For years, we painstakingly practiced and rehearsed and perfected our bread-and-butter medicine. But as we went through our training, one elective, rotation, and course after another, we were not schooled in the business of medicine. Indeed, while were developing the skills to save lives, this felt like the anathema of our purpose.

I first remember really learning about the important role insurance claims would play in my life as a doctor during my residency at NYU in the late 1990s. At the time, the HMO model was fast sweeping across the country. My program had taken the initiative to educate us about these new plans because, we were told, they would directly impact our professional experience as freshly minted MDs. The days of fee-for-service medicine were rapidly shrinking and we would need to become familiar with a whole new vocabulary: formulary and non-formulary, preferred, tier 1, and prior authorization, to name just a few.

Nevertheless, for a number of years, it really felt like the system was working. With some patience and resilience, my colleagues and I would write and custom-code prescriptions for generics, formulary drugs, or alternative infusions to fit each patient’s specific insurance parameters. As the landscape continued to change, we diligently adjusted our expectations and strove to ensure we were doing what was needed to give our patients the best, safest outcomes. But increasingly, it seems, the volume of claims and the challenges of approval have outpaced us, a trend we see evidenced in the renewed interest in fee-for-service models and a growing enthusiasm over concierge medicine.

For most of us, the headache isn’t going anywhere, and fortunately, some insurance companies and startups alike are taking on this worthy challenge. For our part, let us engage our voices and experiences with the discourse. While there is likely no silver bullet solution, if we all work together, we can do better.

Natalie Azar is a rheumatologist who blogs at The Doctor Blog.

Comments are moderated before they are published. Please read the comment policy.

  • Dr. Ivo Robotnik

    My primary concern is about people; an insurance company’s is profit. Rather than working with them, I’d prefer to eliminate this senseless middleman.

    • Lisa

      Without good health insurance, I might have died from breast cancer. At the very least, I would be bankrupt. With health insurance, I am unlikely to die from breast cancer and I am not bankrupt. Without good health insurance, I would be in a wheel chair and in severe pain as I had AVN in both hips. With good health insurance and two hip replacements, I am quite active and pain free. Theoretically, I could have traveled to Europe or India for semi-affordable hip replacements (around $12k) but I didn’t need too. My neighbor down the street also has had two hip replacements, He couldn’t have afforded to travel out of the country for surgery, but with good insurance he is not disabled.

      How do you propose people pay for health care beyond routine matters without insurance? Would you prefer a single payer system? Or perhaps you think only the wealthy deserve health care?

      I would love to see a single payer system in the US or at the very least, some system where the governement limits the profits of insurance companies. But until that happens, I am glad to have insurance and I am glad that the ACA prevents me from being denied insurance due to my prior conditions.

      • QQQ

        “We should have Single Payer system”

        Not when you have a country that is BROKE.

        Not when you have millions of Americans & illegals not working and/or paying taxes.

        Not when you have 318,000,000+ in the U.S., compared to U.K. and Canada which have far less people.

        Not when California has a greater population than Canada and is in a financial crisis.

        Not when Medicare & Medicaid are breeding grounds for crooks to take millions (if not billions) from fraudulent claims and leave it to the U.S. tax payers with rising costs.

        Not when you have a VA scandal that shows its irresponsibly of the government to help its fellow veterans and citizens.

        Not theoretically possible to have single payer in this multicultural society to do so

        • Lisa

          I reject what you are saying for all sorts of reasons. It is possible if the money that is going to insurance companies is funneled to providers via a single payer system.

          1) This country is not broke.
          2) Millions of Americans are retired and are already receive medicare – a single payer system.
          3) People who are not documented pay taxes.
          4) California is not in a financial crisis. The state has a surplus this year.
          5) There is fraud in any system and it can be controlled. You have to devote resources to do this though.
          6) The VA scandal shows that you can not simultaneously cut funding for medical care and simultaneously make impossible demands on the system. That does not mean a single payer system is not possible.

          The real reason a single payer system won’t happen is because the right wing of this coungtry do not want to see it, the insurance companies don’t want to see it and corp medicine doesn’t want to see it.

          • QQQ

            The country is not broke? Judging by the huge numbers going up & up & up!

          • Lisa

            I disagree with you. A single payer system is entirely possible in this country except for the fact that the right wing, the insurance company and corp med don’t want to see it.

            The examples you give of problems with single payer systems don’t convince me that one is not possible. All the examples do is convince me that every system to pay for health care has problems. But I still prefer a system where health care is not limited to the wealthy and the middle class and poor go without.

          • QQQ

            You disagree with me again even after you deleted your first disagreements and disagree with now your personal opinions?

            “Get your facts first, then you can distort them as you please.-
            Mark Twain

          • Lisa

            I didn’t delete my first comment. I have no idea why it was deleted. I just didn’t feel like repeating myself because the post was pretty much a repeat of what I have said to you in the past. You keep on saying the same stuff, I disagree wtih you and we get nowhere. What I haven’t heard from you is how you think health care for those without momey should be financed.

          • QQQ

            That option is available next to you on your right hand corner from your name!

          • QQQ

            “I didn’t delete my first comment. I have no idea why it was deleted. I
            just didn’t feel like repeating myself because the post was pretty much
            a repeat of what I have said”
            So in other words you did delete it, but denying you did it! Make sense.

            I’m not repeating myself. I’ve been giving you hard evidence and not personal opinions on single payer! What I’ve been giving to you in links is logical information while your arguments is about your own personal emotions!

            Might as well end this argument now! Just move on and well talk on another topic on this site without hating each other!

        • Gibbon1

          >Not when you have a country that is BROKE.

          I always love this one, it’s a thing that someone who is completely incapable of thinking past the propaganda would say.

          >Not when you have millions of Americans & illegals not working and/or paying taxes.

          Well certainly there is a fair number of people not working. A sane system would find a way to make them useful. The current system sees them as a way of keeping labors share of compensation down.

          Illegals pay taxes, use few government services, and typically are young and healthy.

          >Not when you have 318,000,000+ in the U.S., compared to U.K. and Canada which have far less people.

          This an argument that essentially says. We can’t cause ‘reasons’

          >Not when California has a greater population than Canada and is in a financial crisis.

          Except California is mostly past it’s budgetary crisis at this point since the Republicans in California no longer have any say in the state budget. (Thank you Prop 25)

          And of course single payer systems in other countries appear to be twice as cost effective as the current US system. And yes I understand your argument, we can’t do that because the US has blacks and Mexicans.


          • Lisa

            Thank you. My thoughts exactly.

          • Ava Marie Wensko George

            Awesome response!!!! I am sick and tired of hearing from the NOs!!!! Do we have a problem – Yes. Can we fix it – Yes. Enough said, let’s get busy! Single Payer All The Way!

      • Patient Kit

        I totally agree with everything you said, Lisa. Most people couldn’t get any medical care without some kind of insurance, be it private or government — certainly not specialists, surgery, chemo, CTs and MRI and many prescription drugs.

        I’d be fine with the demise of a profit-driven, private insurance-dominated system — but only if it’s replaced with a tax-funded single payer system for all. This dream some have of eliminating insurance completely and completely converting to a direct pay/cash system is mind boggling to me. If advocates of that think it would be better for most Americans, then they are really very out of touch with the realities of many Americans’ lives and financial situations. Seriously, people who think our entire healthcare system can go direct pay live in a very magic protective bubble. They need to come outside of their bubble and try living on $12 an hour for a while. See how much money they have in their budget for healthcare on that income. Then try the same thing on a $40,000 a year salary (before taxes). Seriously. Where do they think people are going to find the money for direct pay?

        • Mike Henderson

          I may be interpreting what you say incorrectly, but my impression is that direct pay concept is simply not understood and some other system, substituting for direct pay, is being argued against. Your confusion results from that misunderstanding, not in the actual model itself. I am unaware of anyone advocating complete elimination of the insurance system and complete conversion to direct pay, assuming “complete” means paying for every medical service directly out of pocket whether it be a office visit, hospitalization, imaging or chemotherapy. If that is what you believe others are saying, I am unaware of who they are. It certainly isn’t accurate of what I have been saying. It is an argument that is totally off. My frustration with your arguments is that they distract from the concept of direct pay without really debating what direct pay really is.

          • Patient Kit

            The issue of direct pay is clearly a hot button issue here, for people on both sides of it. I’m sorry if I’ve been unclear. I’ll try to clarify.

            In general, in most threads here on KMD, whether we are for or against it, we have been talking specifically about direct pay primary care. In those discussions, I have said, among other things, that two fields of healthcare that are already dominantly direct care — psychiatry and dentistry — raise red flags for me about how direct primary care might work (or not work) for a large segment of the American people. Right now, I think a lot of people are going without needed dental and mental health care because insurance doesn’t cover it and they can’t afford to pay the fees directly. I worry that the same thing will happen in DPC even if it does lower costs for some people. I really believe that a lot of people will lose access to primary care if DPC ever becomes the dominant model. It’s ok in niches

      • Mike Henderson

        The question of whether or not people have insurance is not a black and white, either or proposition. Getting the insurance company out of the exam room doesn’t mean insurance can’t play an appropriate role when it comes to cancer treatment and hip replacements. What Dr. Robotnik is probably referring to is the over reaching intrusiveness, that patients are generally unaware of, that insurance companies have over physicians and the patient care that we deliver. They make a lot of money off of patients, standing between patients and doctor’s, and provide no value.

        • Lisa

          Mike, insurance companies do provide something of value to non-wealthy patients: the ability to pay for health care. And as most doctors in my area won’t see non-insured patients so they must also see some value in patients having insurance.

      • Dr. Ivo Robotnik

        Listen, I’m glad the insurance model has worked out for you and you were able to get the care you need. It’s good to hear of someone that’s had a positive outcome.

        However, you have to consider that you and your neighbors set of circumstances are not the norm. Did your insurance company give you the run around and make you try various “cheaper” levels of conservative therapy before they would authorize to pay for your hip transplants? Because that is the norm for most people. And that raises costs, and extends suffering.

        I don’t know where you get this idea that I just want healthcare for the wealthy. Are you just jaded in some way? That seemed to come out of left field. Everyone should have access to affordable healthcare, period. Figuring out how to make that happen is the tricky part.

        I think in an ideal world, a single payer system would be the way to go. But we don’t live in an ideal world; far from it. Our government reeks of corruption and favors, and a single payer system would never work for in out country as it stands. I’m glad people can’t be denied for pre-existing conditions, but the answer isn’t to mandate buying insurance from these profit-driven madmen and giving them the keys and authority to decide what kinds of care you can and can’t receive. That should be between you and your doctor.

        Insurance isn’t the right model for healthcare. Insurance is betting against the company that something isn’t going to happen. You can buy flood insurance and never have a leaky basement. You can get disability insurance and never become disabled. But at some point in your life, EVERYONE will need to access to healthcare. So the premiums will always go up, you’ll always be paying more than you need to, or else insurance companies would go out of business. And they’re certainly not doing that.

        In the current healthcare environment, I think the best bet is to find a doc that does direct pay, and purchase catastrophic coverage for hospitalizations until the costs come down.

        • Lisa

          My insurance company didn’t give me a run around about my hip replacements. I had my first hip replacement about a month after I saw my surgeon. With my second hip replacement, my surgeon asked me to get a cortisone injection, which helped a lot for six months or so. But when the injection stopped working, my surgeon and my pcp suggested going ahead with the replacement sooner rather than later. I would have been on my surgeon’s schedule that week, but delayed because of work pressures. I’ve never gotten really had problems with an insurance company; most of the insured people I know have similiar experiences. But the people I know who aren’t insured have had problems getting healthcare.

          My asking if you think only wealthy people should get healthcare is in response to your statement that you would like to eliminate the middleman. Most people couldn’t afford to pay a retainer for a DPC and to pay for a high deductible (ie catastrophic coverhage) insurance plan, so that suggestion isn’t going to work for the much of the population.

          The way insurance works is by spreading risk. If the only people who buy insurance are the people who ‘need’ it (in the case of health insurance, the sick and elderly, in the case of drivers, the bad drivers) it won’t work. But it does work if the pool is large. That is why large employers have pay less for their employees insurance than smaller employers or indviduals (pre ACA).

          Other than signle payer health coverage, I think the best thing that could happen to medicine in this country is place limits on the salaries of CEOs in medical corporations (hospitals, etc).

  • buzzkillerjsmith

    Can we work with insurance companies? I can’t. They would like to see me enserfed and I would like to see them eradicated or at least gelded.

    Don’t bet the ranch on me winning.

    • eqvet2015

      I have emasculators and I’m not afraid to use them.

      • buzzkillerjsmith

        You made me LOL. For that I salute you!

        • eqvet2015

          I’m flattered. This might have to go on my CV.

  • Mike Henderson

    Under the current balance of power, no, physicians can not work with insurance companies.

    IF, the appropriate balance of power could be achieved between patients, physicians, and insurance companies, then we could work together. Insurance companies do have a role in the system, but not in the exam room.

    • Patient Kit

      I can agree with this. The insurance companies do have way too much power and agendas that conflict with both doctors’ and patients’ agendas. The truly ironic thing about my position against direct pay is that I hate insurance companies as much as most doctors hate them.

      The difference is that for many patients, myself included, insurance is a necessary evil. I’m all for the elimination of health insurance but only if it is replaced with a system that provides good, affordable healthcare for all. I can see a single payer system doing that. I don’t see DPC doing that. I do get that DPC could lower costs for some and allow docs to spend more time with some. I just worry about everybody else who it won’t work for.

      Nobody is more disappointed in the unaffordibility of the ACA exchange plans than me. But one of the best things the ACA has done is regulate the insurance industry on their treatment of people with pre-existing conditions, a huge a growing segment of the population since people survive and live long lives with serious conditions these days. That is a good example of taking away some of the insurance companies power. But it needs to go much further and, as you say, get the insurance companies out of the exam room. The process of pre-approval, for example, needs to be tackled.

      • Mike Henderson

        This response will test the limits of my communication skills – there seem to be two issues we are talking about. One, which DPC is directed at, is the issue of delivery of basic health care services provided by primary care physicians. Primary care is overly expensive to deliver and excessively costly for patients to pay for. Additionally, we are practicing below our capabilities – in other words, the current relationship between physicians, patients and insurers obligates mediocre, low value/expensive care. DPC allows physicians to practice at the top of our capabilities, improve quality and hopefully, lower costs to the whole system. Both insurers and Medicare/Medicaid act to protect their interests – insurers protect profit (which is understandable to some degree) and Medicare to protect their control. They make policy decisions to protect their interests to the detriment of patients and physicians. I suppose they actually believe they are protecting patients, but really do confuse what is in their best interest with what is in the best interest of patients.

        The second issue is that people in poverty can hardly afford to pay for anything. They need help with food, utilities and healthcare. You are correct that DPC doesn’t directly address this problem. But poverty is a separate problem. DPC can help them indirectly. What if all the people that I care for as a DPC physician get appropriate healthcare? That means they aren’t over tested, over medicated, over imaged, and are provided the right amount of care? That means that money is not spent that would have been spent in the current system.This lowers overall costs for everyone and makes it easier for whatever solution is created to deal with those in poverty.

        Healthcare is too expensive for many reasons – new technologies, over use, under use, inappropriate use, administrative costs, profits for companies that provide no value, defensive medicine, lack of transparency, too many invasive procedures and anti-competitive policies. I believe DPC begins to address all of these cost drivers. If so, the solutions to help those in poverty, which is the ethical thing to do, would be that much easier. Therefore, DPC works for those in poverty indirectly and should not be ignored because it doesn’t help directly. To me, it is the first step in helping those in poverty. Trying to cover everyone with the most inefficient system in the world is foolhardy. Of course, I have no proof DPC would do any of the above. If not, if won’t succeed and won’t have any effect.

        • Patient Kit

          First, I totally agree that our healthcare system is way too expensive and that we have to do something about that. From talking to docs here on KMD and from doing some reading about it elsewhere, I think I understand the DPC model much better now than I did a few months ago. And I just don’t have the faith in DPC as the answer that you and some other docs have.

          As I said in another response to you above in this thread, I fear primary care will go the way of dental and mental health for many people, if direct pay becomes the dominant model for primary care. Dental and mental health are inaccessible for a lot of people because they are not covered by insurance and people can’t afford to pay their direct fees. Why should I believe that DPC will be any different than direct pay dental and mental health for many people?

          People below the official poverty line have Medicaid. But what about the millions of Americans who are just above that line and, therefore, do not qualify for Medicaid but don’t make enough money to pay for DPC?. People making $12/hr make $20,000 a year (before taxes). $13/hr is roughly $23,000 a year. Not official poverty but no way to afford healthcare. We need a system that covers them. And there are a lot of Americans in that economic class.

  • W Joseph Ketcherside, MD

    Didn’t see any comments about this issue. I wonder if the insurance companies review the appropriateness of claims because they experience hundreds of millions of dollars of outright criminal, fraudulent claims, on top of the number of inappropriate studies that are ordered by physicians? How do you suggest the insurance companies determine which claims are from the wonderful doctors like each of us, and which are from the organized criminals and the poor misguided doctor down the street that keeps sending you those patients with the crazy treatments?

    I know it’s been fashionable to complain about the payers having the audacity to question OUR decisions about anything since the first insurance company was started. But having been around a few years, I still get hung up on how they know us from those other people.

    When you get the check at a restaurant do you look at it to make sure it has the right items on it? When you hire a contractor or have your car serviced, do you check each item? Do you question what the mechanic is doing? Or do you just write the check without ever asking? That’s what I thought. So why do you think it’s any different when you send a bill to an insurance company?

    The debate about single-payer is not really the issue here. We would have questions about the appropriateness of care no matter how many payers are involved. The author’s question seems to be more about how physicians can work with whoever is paying to make sure that appropriate care is promptly reimbursed and inappropriate care is not. That issue is not going away.

    We need to figure out how we can streamline the process so it doesn’t stand in the way of patient care or add administrative burdens. But the process is there for a good reason.

    • FEDUP MD

      The pendulum has swung too far the other way. It now is at the point where I have to sit on the phone for EVERYTHING. Case in point, I had a kid with a history of posterior fossa brain tumor, treated, with new headache. I spent 20 minutes on the phone explaining to the insurance company why an MRI might be warranted. My third grade educated grandmother could have figured out it was necessary.

      It is at the point where they figure if they put up enough roadblocks we’ll run out of time and they will save some money for their bottom line denying needed care.

      • W Joseph Ketcherside, MD

        I understand what you are saying, but I’m watching TV news right now, and they just read from a 2010 OIG report that found $6.7 Billion in wrong Medicare claims. 42% of claims had the wrong codes on them. Until this starts to improve dramatically I predict that the payers are going to keep trying to show that they are getting what they pay for.

        BTW, I’m a neurosurgeon so can totally relate to the MRI call – and usually I had to spell “posterior fossa” to them so they could look it up. It is maddening. There needs to be a solution. But it’s not going to go away, and it shouldn’t. Not with billions of dollars at stake.

        • FEDUP MD

          I wouldn’t leave it at just maddening. That is time I am not using seeing a patient. In this day of doctor shortages this affects everyone.

          • W Joseph Ketcherside, MD

            You are right. What do you think could solve the problem? Given that there’s no way we will just go back to they pay for anything you order, that is. I noted one potential above, an automated decision support system based on the patient’s integrated EHR data which would automatically approve the majority of studies and treatment recommendations.

            Do you have some thoughts about potential solutions? Love to bounce some ideas around here.

          • FEDUP MD

            I am not sure there is an answer, short of insurance companies trying to do right by their patients who pay premiums rather than their administrators +/- stockholders. They have no incentive to even give needed care because it impacts their bottom line. Perhaps relaxing the laws pushed through Congress making them largely immune from being sued by individuals? They are essentially answerable to no one. Maybe if John Edwards got a few multimillion dollar settlements out of them denying care with a bad outcome they would rethink what they denied.

          • Patient Kit

            That is a good place to start: Tackling those laws that make insurance companies answerable to nobody and unsueable when they deny and delay care that results in unnecessary bad outcomes for patients.

            Why should doctors be sueable for malpractice and insurance companies be untouchable? When insurance companies get between doctors and their patients when making important medical decisions, those companies are, in effect, practicing medicine. They should be held accountable when they force a decision that hurts a patient.

            If insurance companies are going to remain a part of our system — and, short of a single payer system, I don’t see insurance companies going away — we need to build on the pre-existing conditions clause in the ACA and make other changes that make insurance companies more accountable for things besides their own bottom line.

      • W Joseph Ketcherside, MD

        You know, I always thought that with an EHR and data integration with the payer, a good decision support system would automatically know that the MRI was appropriate and would approve it without any human involvement at all. But that would just make all the docs who hate EHRs mad.

        • DeceasedMD1

          I think we were all sold a bill of goods-that EHR’s were for our benefit and would make these transactions simpler as you pointed out. EHR’s were not made for us or pts. Of course the reality is the data collected is worth a fortune to many medical and Big pharma companies alone. And of course the number one answer is billing.As I am sure you have witnessed EHR’s have destroyed any semblance of a medical record.

      • Lisa

        The one thing the ACA does limit profits for insurance companies. At least 80% of the premium dollars have to be spent on claims and activites to improve health care quality. Insurance companies also have to justify increases of over 10% to the state. I wonder what effect this will have is on denials of service.

        • Arby

          Ok, I’ll make a wild prediction. They raised their rates earlier than ACA implementation to give them a head start on cost increases. Now that they are higher than ever and ACA kicked in, they will lay off their own staff and delay any approval they are legally able to and roll the money while delaying payments. Even if I am wrong on this scenerio, they are still going to find a way to kept their profit margins insanely high.

          • Lisa

            Who knowswhat will happen; but remember that insurance companies do have to spend at least 80% (85% in large markets) of the premium dollars they take on claims as I mentioned above. A lot of money had to be returned last year and even those insurance companies who didn’t have to return money had to notify the people they insure about this aspect of the ACA and why they weren’t getting any money returned. I actually think the profit margins for insurance companies are going to be a lot thinner than they were.

          • Arby

            And banker’s bonuses went down after the bailout…

            Perhaps, I should have argued the point about executive compensation at health insurers.

            I guess we’ll see one way or the other.

          • Lisa

            I didn’t say anything about the bankers bonuses; I think some/many of those guys should have gone to jail.

          • Arby

            No worries; I didn’t say you did. It was an observation, and why I don’t think health insurer executives will be in poverty anytime in my lifetime.

          • Lisa

            Well, I agree with you that I don’t think any health insurer executives will be in poverty. I jjust think the companies’ profit margin will be constrained.

    • DeceasedMD1

      A simplistic answer is that each system is exploiting the next. Is it ethical for a hospital to charge insurance $13000 for an abdominal and chest CT scan? Or $12000 for a pt getting a straight forward 10 minute outpt minor surgical procedure? Those are just a few of the recent charges both from hearing from pts and family members.
      They start with these outrageous charges and then thousands of admin to admin calls between hospital and insurance haggle over the price to 30 percent or so as I am sure you know.
      Through the eyes of insurance, I am sure, they know they are being exploited with insane costs and just create obstacles for every procedure and authorization even legit cases that are in dire need. I am sure they can’t see the forest from the trees with this kind of extortion. So they push back with obstacles, and docs and pts are caught in the cross fire. More admins hired to fight with each other from each camp.
      The only answer I can think of is a sense of reasonable costs for procedures or some sense of fairness on both sides. But of course that is a pipe dream.

      • SherryH

        Great post Deceased. I think that says it all!

        • DeceasedMD1

          Thank you so much Sherry. I don’t think capitalism is technically suppose to work this way but that’s the way it goes these days. Are any of these experiences sounding familiar to you?

  • eqvet2015

    Party pooper.

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