Unpaid Demands of Insurance Carriers

As someone who might have some insurance coverage that claims to “cover” acupuncture services, you might think that your provider is being reasonably compensated. In all but a minority of situations, “in-network” providers are paid very poorly. They are not paid for their expertise, for the time it takes to do a thorough diagnosis or evaluation, nor for the time they spend doing the treatment, for all the insurance verification and billing, for the accounting required, for their overhead, let alone anything left over for take-home.

Seriously, insurance plans and the third party administrators are making huge profits while providers are expected to go bankrupt for the sake of their patients and the insurance plans.

For example, start out with the contracts and policy manuals that the carriers and third party administrators expect providers to read, understand, and follow. Are they paid to review these? No. Are they paid to take the time to understand them? No. All of that is on their free time. No providers in the acupuncture world are on salary if they have to know all of this. And the number of acupuncturists on salary? Infinitesmaly few.

Unpaid Demands of Insurance Carriers

Here is a 4 page document listing only a small number of plans. This mailer is required reading for by providers.  It is just a drop in the bucket of the papers and documents that are supposed to be read by providers and their staff.

Please take the time to read it and understand it. How much time did it take you? How much should you be paid to have to do that? Please let me know.  Because providers get zip for doing so. And if they have staff, they have to pay them to take the time to read it.  Who pays for it?  Not the insurance company.

On the other hand, how much were the writers of this paid to create it? Mucho dinero. Believe me. It is the administrators, the JACO inspectors, the policy wonks, the CEOs who are making millions off of this. But the providers you rely on for help? NOTHING.

And the administrators will blame it all on regulations. Regulations that they created to obfuscate and then blame providers for not following.

Unpaid Demands of Insurance Carriers

And I bet that your insurance premiums are going up astronomically. My personal Kaiser policy is going up 21% this coming year. Is there any corresponding increase in fees paid for treatments done? Ha Ha Ha. The jokes on you if you think that independent providers get an extra cent from the increase.

No, the joke’s on the providers who accept the plan payments. Like The Redwood Clinic. SUCKERS!!!

Is there any increase for even increases in costs? Rather, the fees continue to be cut with more and more demands to do more for free.

Unpaid Demands of Insurance Carriers

Insurance carriers and third party administrators are laughing all the way to the bank. And providers are dropping like flies. That is why there are so few providers accepting insurance. MDs, unless they are part of a medical group associated with a hospital/insurance plan complex.

The truth is, those providers lucky enough to get a job with such a medical group/hospital complex are a rarity in the alternative medicine field. The jobs are rare, and the insiders are all referring their friends to get the insider-employee referral fees. There is no hiring based on experience, it is just new-age nepotism. Speaking from experience. Age discrimination is rampant in this system apparently as well. The MDs I spoke to 2 – 3 years ago were all retiring because the system was starving them out of business. Years of clinical experience are a noose on a resume.

Unpaid Demands of Insurance Carriers

How many plans are there? Unknown, but here is a single sheet of paper distributed that is supposed to be memorized by providers. Hilarious if it weren’t so obviously clear proof that the system is broken.

One online insurance billing and verification system list 7370 insurance payors. Seven Thousand Three Hundred Seventy. What if you personally had to know which to chose to get YOUR salary from? Crazy. No, insane. But that is the system. This list is just the first 50.

The fact is that suggesting any of the above, no matter how based in fact, puts a mark on my chest, a target on my back. Was this the reason I was taken off a Kaiser referral list, in spite of the fact that I was being paid 30% – 100% less than other contracted providers? This was sex discrimmination. And would Kaiser and any of the six executives there answer any questions I sent by certified mail about the reasons for the termination? No way.

Which is sad to me because I have provided excellent service to patients there for years. Numerous patients were very upset that they couldn’t get continued care with me and Kaiser refused to explain to me or them the reasons. They wrote letters on my behalf and Kaiser officials and employees refused to provide any response.

I have also been a member of Kaiser myself for years. Paying huge premiums that have paid for the salaries of executives and middle managers in the Outside Referrals Deparment. What do you think? Should I change to another plan during this time to change Covered California Plans?  Why did the following executives of Kaiser NEVER bother to respond to my letters? Pragya Wagle, Nicole Lipes, John Loftus MD, Deborah Gould MD, Lawrence Hamilton, Anita Zuniga RN, Millicent Brown Hunter RN.

“PEOPLE ABOVE PROFITS” is supposed to be the motto of Kaiser Permanente.  The actions of the leadership are wholly inconsistent with this philosophy in the way they have disregarded a very loyal consultant of 20 years.

 Tags: Pragya Wagle, Nicole Lipes, John Loftus MD, Deborah Gould MD, Lawrence Hamilton, Anita Zuniga RN, Millicent Brown Hunter RN.