As health regulations and malpractice lawsuits increase, doctors have increasingly needed support staff to help them navigate the morass. Large hospitals and clinics have such support on staff, so doctors increasingly have found it easier to join such institutions, than to run their own private practice. But a trade-off is that they give up considerable autonomy, making the practice of medicine less fulfilling and risking burn-out. To protect themselves and their institutions, doctors must follow the protocols rather than follow their experience-based judgement to innovate for the benefit their patients.
(p. A6) The killing of a top health insurance executive outside a Midtown Manhattan hotel last week triggered an outpouring of public anger at an industry many Americans blame for the ills of the nation’s healthcare system.
Count doctors among the aggrieved.
. . . Doctors say their frustration is born of intimate experience and has been building for years.
Their chief complaint is the aggravation and expense of convincing insurance companies to pay them for their patients’ treatment. Even when they are ultimately approved, MRI scans and other vital but costly procedures often require days of campaigning and paperwork, say doctors.
“It’s getting worse,” said Dr. Zulfiqar Ahmed, an internist in Augusta, Ga., who has practiced in the U.S. for 35 years. “This is not only UnitedHealthcare—this is universal in this country.”
. . .
“They hire certain doctors, and they sit at a desk, and their whole purpose is to deny or delay,” Ahmed said, echoing a common complaint among doctors.
. . .
In a recent post on X, Dr. Alan Nguyen, a spine specialist in Fort Myers, Fla., noted that when insurance-company doctors reject an MRI request, he now asks for their name and health provider identification number. “I tell them if a cancer is missed, then the patient will know who to sue,” wrote Nguyen. In an interview, he said he believes the situation had worsened significantly over the last five years. When insurers denied treatment, Nguyen observed, doctors were still left to deal with the patients and their pain.
A familiar lament among doctors is how sweeping changes over the last 20 years—some instigated by insurers, others not—have degraded their profession. Once autonomous and highly esteemed, doctors are increasingly employees of large hospital chains and find themselves trapped between insurers and their own cost-conscious management.
. . .
Dr. Richard Lechner, a family dentist in New Britain, Conn., for years paid for three administrative staff members whose days, he said, were mostly spent fighting with insurers. This for an office that consisted of one dentist and two hygienists.
“They’re always throwing up roadblocks for practitioners like me to get paid,” Lechner said. Requests for additional documentation, or claims of paperwork lapses, were, he said, “specifically designed to prolong, prolong, prolong and then hope the dentist gives up.”
Last year, Lechner did give up: He sold his private practice to Dental Associates of Connecticut, a company that operates a network of more than 40 dental offices across the state. Like Davidian, he is now an employee. Much of the work of chasing insurance claims is now handled by a specialist team at Dental Associates’ central office.
“The primary reason I sold my dental practice is because I couldn’t keep up with the insurance companies’ shenanigans,” he said. “I thought I was going to have a stroke.”
For the full story see:
(Note: ellipses added.)
(Note: the online version of the story has the date December 12, 2024, and has the title “Doctors Say Dealing With Health Insurers Is Only Getting Worse.” Where the online version provides somewhat more elaboration than the print version, the passages quoted above follow the online version. In the print version, but not the online version, the last four paragraphs quoted above appear in a separate boxed sidebar with the title “Dentist Gave Up, Sold His Practice After ‘Shenanigans’.” In the online version, the paragraphs appear at the very end of the main article, with no separate heading or sub-heading.)