MANAGEMENT ESSENTIALS

Physicians deserve a better breakup with insurance companies

Impersonal business tactics of insurance companies have all the finesse of a teenager’s text message.

By Farrell “Toby” Tyson, MD, FACS

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.

Growing up and having kids has allowed me to see the differences in culture over just one generation. Breaking up with your girlfriend or boyfriend used to require a face-to-face encounter. Human interactions and body language help convey emotions.

This younger generation, however, doesn’t have a problem severing relationships with a text message. Hiding behind a smartphone may initially shield one from hurt and disappointment, but being unable to read the true context and effect of the person on the other side may leave a lasting resentment.

THE COLD SHOULDER

Recently, UnitedHealthcare decided to sever their relationship with the majority of high-quality, high-volume practices in Florida. Our practice was one of them. We found out not from our UnitedHealthcare liaison, but from a patient’s complaint over a letter from UnitedHealthcare. The letter said our practice would no longer be a provider as of January 1.

Before this, we had heard about insurers dropping practices in northern Florida and had attempted for several weeks to speak to our liaison at United-Healthcare. Our phone calls were not returned. Eventually, several days after our patient’s concerned phone call, we were able to get a call returned verifying that we were to be dropped and we should be receiving a letter to that effect.

NEGOTIATING TACTIC

This impersonal way of doing business is becoming more common. While this is probably a negotiating tactic to wring more concessions out of doctors, it creates an adversarial relationship. Of course, like most other practices in this situation, we are appealing the decision. Explaining the value proposition to a faceless, emotionless corporate entity requires a great deal of time and effort.

Do issues of patient care truly matter? Does access to quality care mean anything? It is difficult to have a meaningful and productive discussion when you are not sitting face-to-face.

NOT A SECOND TIME

Believe it or not, our practice has been through this before, with a different insurance provider. It became clear during the appeals process of that case that the company felt we were an “over utilizer” of services.

Upon further questioning, they stated that our ratio of E/M codes was too high on level four and five codes. I explained to them that our practice really didn’t use E/M codes but rather eye codes. Not surprisingly, they had no clue what an eye code was and their records showed that we had only used the E/M codes 29 times over the last year between six providers. We then showed them our records and analysis. After the meeting, we were reinstated.

Much of this could have been avoided if both parties would have come together before the separation and worked out their concerns. Sadly, this common-sense approach to communication is becoming a thing of the past. OM