Ask any doctor what they think of payers and they’ll likely say things that can’t be printed.
The relationship between physicians and payers has always been turbulent, mainly because they serve two different masters: Doctors are trying to provide the best care possible while maximizing revenue to their practices; most insurance companies are trying to provide the best care while increasing profit for shareholders and minimizing costs to employers.
With employers putting increasing pressure on insurers to freeze or lower prices, physicians often get caught in cost-reduction efforts from payers. Throw in a dose of government regulations that make doing business more complicated and you create an environment that can lead to frustration for physicians, as evidenced by the Medical Economics Payer Scorecard, which shows an overall low opinion of payers among physicians.
Insurance companies score low (under five on a 10-point scale) in customer service, payment, patient information and communication with practices. Doctors feel increasingly helpless and confused by what payers are doing and question how payers’ policies are saving money or improving care. They see insurers as “playing doctor”—making decisions on what treatments are proper—and ignoring their medical training and familiarity with the patient.
“Most of our time is spent doing soul-crushing paperwork for no reason—it doesn’t help with anything,” says David Belk, MD, who runs a solo internal medicine practice in the San Francisco Bay area. “They [commercial payers] are trying to distract everyone with this image they are saving the healthcare system money when in reality, their revenue keeps going up and up.”
Bottom line: independent physicians struggle with cash flow, hoping to get paid properly and in a timely manner while health industry juggernauts post multi-billion dollar profits.
What physicians consider necessary and practical care is often challenged by insurers who have no relationship with the patient. For example, ordering a CT scan for a possible case of diverticulitis requires a prior authorization, which appears to Belk as though the insurance company is trying to be the doctor.
“I don’t get paid extra for the scan. Why does a nurse from an insurance company have to sign off on that? How is that about saving money?” says Belk. He points out that the bigger risk to the insurer is waiting too long for the scan, which could lead to severe consequences for the patient.
“I’m prescribing what I think is necessary and I have no financial incentive to do so,” says Belk. “And why are they issuing denials on meds that cost less than the copay?”
According to our survey, three areas stand out as the biggest frustrations for doctors: an increase in prior authorizations, an unwillingness by payers to negotiate reimbursement rates and an uptick in claim denials. Here’s why payers are taking these actions.