For a physician or physician group in private practice, every year, this industry gets more complicated, making it harder to get paid for what you do. The insurance companies are squeezing every bit from the providers; denying more and more claims incorrectly, global payments, downcoding claims and delaying payments for claims.  All of this, while the insurance companies are making record profits. Patients deductibles are increasing and insurance rates for employers are continually going up every year.  Who is benefiting?  Not you!  Insurance companies aren’t physicians.  Why do we keep letting them practice medicine?

I recently had an experience with one of my providers.  Blue Cross was wanting to “test” a global payment structure and for the next year, pay a “bonus” for having the physician show them how they can save money.  They gave a budget (from 2019), and then said if the physician can save money for their patients greater than the 2019 expenses, they will bonus the providers.  First of all, I don’t know about you, but my expenses have GREATLY increased since the pandemic and 2019.  I believe this is just a way for them to gather information.  I’m not sure how this is a benefit to anyone other than the insurance company!  Their goal is NOT to help the providers.  It is to lower the reimbursements and make more money for themselves.

What are the solutions?  I believe there are some!  Your specialty associations, CMA, AMA are all places where you should be going to voice your concerns.  If they do not hear concerns, they can’t help to make the changes.

Don’t wait until it’s too late and bad policies are in place.  Voice your concerns!

-Janet Selover, President & Founder