Why a doctor stopped taking a particular health insurer

For the moment, I still take almost all insurances in my practice. And as long as I see enough patients (i.e., as long as the phone rings) I’m doing OK. I’ve been billing electronically with a free clearinghouse for about five years now, and things are pretty good.

Over all these years, I’ve only dropped one insurance company. It covered a fair number of patients, including many of my favorites. It paid terribly, though I’ve recently realized that there’s another plan that pays even less. So why did I drop that one plan?

It was the hassle factor.

For some outrageously obscure reason, this insurance insisted on using my employer ID on claims instead of the SSN accepted by every other insurance. I had to remember to go in manually every time I created a claim and switch the numbers around. Given how poorly it paid, eventually it got to the point where it wasn’t worth it. I tried calling the plan to see if I could negotiate a better rate. Suffice it to say, they offered only two options: Take it, or leave it. Many of the people who already had that plan still come to me and just pay cash, given that my fees aren’t all that high to start with. Others went and found new doctors (and some of them came back again, happily paying for my care.) And when potential new patients call asking if we take that insurance, we have to say, regretfully, no. We’ve moved on.

I mentioned another plan that also pays very poorly. Why do I keep it?

It may not pay much, but it pays promptly and easily. Billing is as easy as point and click. Sure, I need the documentation to back up my services, but it’s not all that hard electronically to edge up the difference between a level 3 office visit and a level 4. Knowing which plans pay less than others, I’m more likely to — not exactly fudge; let’s say — take a little extra time with the patient, then go ahead and be sure to code fully for my services.

What about the better paying plans? Interestingly, if I know I’m going to get all or nearly all of my fee for any given level of service, I’m less likely to try and squeeze out every last nickel from each visit.

On balance, it’s probably much more economical for an insurance plan to pay me, and by extension all physicians, reasonable rates for our services instead of trying to ratchet us down so low that we have to game the system in order to make ends meet.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

Image credit: Shutterstock.com

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