No Insurance Part 3 – The Insurer
** This blog was written before FL Blue’s invitation to join their commercial network in Dec 2022. We have resumed to accept insurance on 3/15/2023. Your insurance will still need to be verified for coverage.
Also known as the insurance company. (Remember: Your doctor isn’t God)
In May 2022, United Healthcare reported $5 billion profit. CVS health $2.3 billion profit. Anthem Blue $1.8 billion profit. Cigna $1.2 billion profit. Humana came in 5th at $0.9 billion profit. Hmm…………
Disclaimer: The follow is fiction for entertainment. If it happens to be true, it is just a coincident.
{How did they do that ? Simple business strategy: By increasing premium paying members, minimize paying the claims and use more “off shore” support.
First is to attract more paying members, design a plan with high deductible. Confuse the members with coinsurance, making them think they only have a small copay. Tell people their plan covers many things but making it financially difficult to use. Put a lot of fine prints in the policy. Most do not read the entire policy before they sign. Those read the policy usually do not understand most of it.
The second and the latter seem to discourage providers to accept their members as patients. After all, if a doctor is not taking a patient, there is no payment. How wonderful for the insurance company to only take money from the members but has no pay out to the providers !
When an insured member call the insurer, they are served by on shore support. However, provider calls are redirected to off shore support to face language barrier and “read from the screen” issues (increased frustration).
Sometimes, the reason for a claim denial is not a legit one. Typically the reason of denial is vague causing a lot of guessing work. Calling the provider support is usually of no help. An example is a denial with “additional information is needed” reason but no mention of what information is needed or missing. The EOB arrives in a few weeks saying incorrect NPI number. Record shows the NPI has been correctly put in. The insurer is requested to reprocess the claims. It will take probably two to three months to see the corrected EOB with payment (or no payment). This is obviously a mistake at the insurer but the multiple phone calls, language barrier and the running around definitely discourage the provider to give service to the insured.
Besides, the insurance God makes his own rules. They always response with “Filing a claim does not guarantee payment” after the provider submits a claim. The rules also make a lot of patient’s lives harder. If you need an MRI, they may denied it and put you through PT or Chiropractic while your pain level is at a 20 of 0-10 scale. Then you may just allowed an xRay but pain remains. You will endure another few weeks of pain before you will have a chance to be approve an MRI to correctly identify the cause of your pain.} (End of Fiction)
Acupuncture clinics are typically small business operation. There is limited resources (time) to spend on insurance issues. Acupuncturists are very caring and they spend a lot of time with their patients (top priority). This makes it not feasible to operate with the additional burden from insurance processing.
