Fighting the good fight

One of the most frustrating things for a doctor, any doctor in this current health care environment is dealing with managed care companies. Many fine physicians, from my neurosurgeon, to others have actually opted out of the managed care networks either partly or altogether because of either underpayment, non payment of approved services or burdensome paperwork requirements that do not improve the quality of care, but does increase the stress level of the practitioner.

The other day, a long time practicing chiropractor I know who has helped thousands over the years and was the treasurer of our chiropractic sports council did the ultimate in opting out. He left the profession for good. Knowing what todays practice environment is like, it is really tough to stay in practice with the attitude of wanting to help others because the insurance companies and their cronies such as american specialty health, ACN group, Landmark Healthcare and others have increased the stress and paperwork on chiropractors while decreasing their reimbursements. Imagine if every year your employer had you work more hours, had you fill out paperwork to justify your very existance with the company and then instead of paying you more, paid you less with the money that you should have earned going to a company whose sole purpose is to dehumanize patient care and make another department wealthy at your expense.

This is what it is like to practice today. I may sound negative but these are todays realities. The other day, a month after filing an appeal, we received notice that ACN group has officially terminated us from United Healthcare as of December 2006. The reason for this had little to do with quality of care, but with cost. We have a specialty practice that handles many complicated myofascial issues and the visits may be longer than the quickie treatment they would like to see and although we are in line visit wise, our costs are higher. Their solution is three tiers. First tier is non limiting. If you don't reach their financial goals through downcoding yourself voluntarily (charging them for the minimum even when you do the maximum), they then put you in the second tier in which they limit your visits and fill you with continued extra streams of paperwork. When this fails to do what the first tier did, they then send you a contract to shape up or get kicked out. Since they do keep stats (not sure how they did because up until recently, so few of our patients required their paperwork), they used these stats against us and asked us to see our profile on line on a quarterly basis. In other words, keep your numbers low, irregardless of what you do in your office or your're out. We did make a conscious effort to improve our numbers and they did improve, but apparently not enough.

Our stay in the network has been further made uncomfortable by their auditing of certain patient files (they want the power to ask for money back if you forgot to note something even if you performed the service), they are downcoding from what we are doing on claim payments (causes cash flow shortages and we cannot budget monthly expenses and it of course if illegal), they are misinforming us as to who needs to be precertified, and then ignoring the proof showing it is their fault, not yours. This makes us crazy because they then tell us to send it to second tier review. All this does is increase practice stress and drives us crazy. They also deny the first visit if you dont file paperwork, even if the person only needed one visit. If this sounds like they are trying to dehumanize our profession and create unnecessary angst, it is what it sounds like and from what the American Chiropractic Society tells me, they have dismissed about 1/3 of their doctors from their network nationwide. After hearing all this, why should I want to be in network? The more I think about it, out of network is sounding better and better.

Although being in network has its appeal, many of our united clientele will likely stick with our office because we provide a level of service that is difficult to find in the chiropractic arena in our area. We will also be reimbursed at a better level out of network as well and likely be able to totally avoid the ACN paperwork.

From what I hear, there will be a lawsuit. ACN is owned by United Healthcare. United Healthcare continues to bully doctors around. Recently, we were told that if we did not agree to voluntarily get electronic statements, they will do it for us and then gave us a deadline, instead of the typical mailed statement. This will save them millions in postage, yet your premiums are likely increasing for health care again this year with an increased co payment.

Getting back to the good fight: I wish to be able to practice in a free environment. Free to help others. Many are just slipping through the cracks in our healthcare system. We help many of them after their doctor sent them for tests that cost more than the care to resolve the condition. Yesterdays new patient was a perfect example of this. MRI, x rays of hip when his lower back and pelvis were twisted from a back sprain and it was clearly visable, all you needed to do was look at the person.

Not sure where to go after this but this gives you an idea of what it is like from the chiropractic perspective in the health care battlefield