Latest  Insurance Scam

Latest Insurance Scam


The Death Of Paper Checks

During the global pandemic of 2019-2021, the managed-care insurance industry has the chutzpah to stop paying for medical care by checks as they have for the last hundred years. Many are now issuing “gift cards,“ weeks after the care was delivered, that require a credit card machine, monthly service fees to a bank, and a percentage lost to processing fees. Horizon Blue Cross Blue Shield of New Jersey, our local 800 pound gorilla example, and United Healthcare (UHC), the largest health insurance company in the United States and perhaps the world, is another monster pursuing this costly farce. To compound insult with injury, they expire generally in 90-120 days. It could take that long just to figure out the byzantine four-stage insurance-web interface-bank process and be credentialed to be authorized to deposit them!

Another option is direct deposit but gone are the days of mailed printed explanation of benefits (EOB) statements detailing the transactions. With paper trail and check reimbursement, there was a physical record of transaction details that was easier to read and not dependent on electricity or internet connectivity. With purely electronic transactions, mistakes are frequent, easy to miss, and are costly to your business.  

Keeping up with medical coding and billing has become more than a full-time job, but a full-time job with many intermediates and, “business associates,“ on whom you are now dependent and having to pay without the ability to raise your prices like normal service businesses. Pursuing insurance company denials, errors, and reclamation efforts requires much diligence and costs both time and money. 

Imagine you run a business and perform costly services in advance of potential payment (already a stretch to imagine...). You perform the procedure or consultation for the patient, while you have to deal with a multi-million or multi-billion dollar corporate or government third-party to determine payment. Remember, you are accountable and liable for any issues coming from that service, and the third-party has zero liability. Finally, you have to wait 2 to 4 weeks to find out the disposition of your payment. Will your payment get denied? Will the payer demand private patient information? Will the payer downgrade your payment? Will the payer send you a gift card, costing you time and money to process? Will the payer make a direct deposit in your account, with no explanation of benefits distribution, and be able to reclaim the payment at any time in the future? Ridiculous, right? Who would agree to such an arrangement? Physicians… 

The only winners are the insurance companies. There are virtually no advantages for the physician or medical care institution. The costs from time involved of reconciling and posting EOBs, e.g. paper, toner, etc (both paid and denied), now become the overhead of the practice with no incentive or fee increase from the insurance company to cover these costs. Some would say that the cost of insurance bureaucrats adding their two cents to decisions made by patients and physicians is devastatingly expensive in terms of both quality and increased red tape. 

The harmful intrusion of managed-care insurance third parties and their designees and business associates has been incrementally enabled by misguided government programs, like the formation of Medicare and Medicaid in 1965, and tax laws that incentivize employers to offer and control employee health plans. Historically physicians and healthcare entities competed with each other on price and quality. They billed the patient directly at the time of service and costs remained low. But since Congress has imposed intermediaries in the process, costs have been raised exponentially by entities outside the Patient-Physician relationship. New “costs-of-doing-business,“ and cost of complying with government mandates are forever compounding costs everyone pays for “healthcare.“

Payment should be due, or at least payment terms arranged prior to or at time of care, as is done with direct primary care and other direct payment arrangements. Physicians and medical care facilities should have all options of payment available and not be limited to insurance company diktats. United States paper money is legal tender “for all debts public and private.“ This is no longer so with big banks, insurance and government? When managed-care insurance or a government entity makes determinations on the fly and at their whim, it hurts patients, physicians, and all healthcare entities. It only benefits managed care insurance conglomerates and their crony business associates, and perhaps the politicians they pay off with lobbying,campaign donations, and paid board positions with exorbitant salaries after they leave office. The managed-care insurance industry and government “tail” should never wag the healthcare “dog.” 

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