Not Making the Grade

I picked up this tidbit from a message forwarded to PedTalk (thanks, Dr. Gewanter). Family Practice Magazine and the associated AAFP (from whom the AAP is finally starting to learn!) “…decided last year to conduct a Consumer Reports-style survey of physicians’ experiences with third-party payers.”

The results are hardly surprising. OK, I was surprised that United wasn’t the worst payor ranked. Rather than summarize the piece, just go read it here. You can get a copy of the report card here. The quotes from Dr. Edward L. Langston, the chairman-elect of the AMA’s board of trustees and an AAFP member, are priceless. I’m no great fan of the AMA, but he’s got it right here.

• “Many health insurer contracts are essentially ‘contracts of adhesion’ … submitted to the weaker party on a take-it-or-leave-it basis and do not provide for negotiation.” In many cases, these contracts contain objectionable provisions, such as “all products” clauses and “most favored payer” clauses, and allow the health insurer to change unilaterally any term of the contract.

• “Many health insurer contracts make material terms, including payment, wholly illusory. They often refer to a ‘fee schedule’ that can be revised unilaterally by the health insurer, and do not even provide such a schedule with the contract.”

• “Despite the improper restrictions and potential dangers these terms pose, physicians typically have no choice but to accept them. … Choosing to leave the network often means destroying patient relationships and drastically reducing or losing one’s practice. Physicians simply cannot walk away from contracts that constitute a high percentage of their patient base because they cannot readily replace that lost business.”

• “Ironically, rather than focus on the health insurance industry, which … has boasted record profits and increased premiums corresponding to recent waves of consolidation, regulators have focused on physicians, the least consolidated segment of the health insurance industry.”

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