A Statement on Insurance

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A FEW COMMENTS ON INSURANCE.

At the outset, I must say that I am not an attorney, nor am I trained in the field of insurance. Therefore, I am not the one to give you legal advice about your insurance coverage or your benefits due. As you might expect however, after thirty years of practice, I do have several comments about insurance. These comments are based on years of observation in my clinical practice.

In my opinion, insurance has changed dramatically over the last six or eight years. Unfortunately, again in my opinion, the insurance industry is no longer a service industry. Insurance has become the business of management and denial. Every day, we observe patients who are disappointed with their insurance coverage. Every day we observe stalling and delaying tactics which are used to prevent settlement of rightful claims. My observation is that the average response time from filing to payment of benefits (in this office ) sometimes exceeds 120 days. As a businessman, I am forced to say that this is unacceptable.

Your insurance contract is usually negotiated by your employer and a representative from your group insurance carrier. Depending on your employers philosophy and the wishes of the employees, the coverage is usually intended to cover only a portion of certain medical procedures. The various medical procedures to be covered, and what portion of the expense is to be paid by the patient/employee is all part of the individual negotiations between your group or company and the insurance carrier. The more risk the insurance company is asked to assume... the more expensive the coverage becomes for you and your employer. Today, cost cutting by reducing coverage is a common practice in the business world.

Routine medical procedures that are used every day in this and many other medical and dental offices, may or may not be covered by your insurance contract. When a decision not to cover a particular medical procedure is made, that does not mean that the procedure in question was improper... insurance clerks are not trained nor are they permitted by law to make those medical decisions. The decision to cover or not to cover a particular procedure is based on a contractual agreement between your group and the insurance carrier.

No one likes to think of their doctors' office as a business. In fact, most doctors don’t like to think of it that way either. But in the final analysis, in order to continue to be available to serve the public, this office must be operated in a businesslike manner. As a businessman, I can not base the success or failure of my practice on a contractual agreement to which I was not a party. I must make business decisions that give our office a reasonable chance for success. In the light of the above comments, I have established the following insurance policies:

* My office will not accept an assignment of benefits from your insurance company. Several payment options, including credit cards and/or interest free payouts, are available to you. When we do not sign the "assignment accepted" line on the insurance claim form, any payments that the insurance company makes should be mailed directly to you. However, if we receive a check from your insurance carrier, we will accept any payment sent to us and apply that sum to any balance due on your account. If the account balance is zero, the check will be instantly endorsed over to you.

* I know you are not going to believe this (joke), but sometimes the insurance carrier attempts to delay payment of benefits due to you by asking question after question. They know that doctors are busy and a response to the question may take days or weeks. To quickly solve this problem when it occurs, I prepare a Report Of Findings. This comprehensive report is usually 2 to 3 pages long. It is individually prepared. It takes me about thirty minutes to write each one, and we provide it at no charge to you. It answers all the insurance company "stalling" questions. The report contains more than enough information for your carrier to make a benefit determination. The original is maintained in your record here in our office. Copies are available for insurance questions and disputes.

* If you prefer, we can provide you with a completed insurance form following each visit. It contains all of the diagnosis and treatment procedure codes necessary to determine insurance benefits due to you. However, our office is equipped to file your claim electronically. That is very much faster, and we instantly receive a paper "acceptance" which indicates that we have filed a claim to your insurance company with no errors. This acceptance eliminates the old insurance trick "we never got the form from the doctors office".

* Payment arrangements are expected at the time of service. My office will make a reasonable effort to establish a payment plan that is affordable for you and fair to me.

* Often the insurance carrier will respond more quickly to the person who is paying the premium. My office will make every effort to help you to answer insurance company questions and to comply with insurance company requests.

I hope that this short explanation will be helpful. At first reading, these policies may seem harsh, but if you will think about them in the light of current insurance industry circumstances, then I feel that you will agree that, for a business owner, they make good sense. As always, my staff and I are dedicated to assisting you in receiving the maximum benefit from your insurance carrier. We are available to discuss individual circumstance and answer your questions. Please do not hesitate to ask.