One Comment

    July 13, 2017 @ 5:46 am

    Thanks for a well written piece articulating my own perspective on education and full disclosure in controlling costs in healthcare. I wrote about the cost of Healthcare in this article below:

    What I may not have mentioned is the fact that our US Healthcare system is the only industry worldwide in which payment can be denied after services have been rendered. Strange how that happened!!!

    This became reality because we as patients and healthcare providers are not educated in the insurance catch-me-if-you-can games. Like you said, there is no requirement for full disclosure and so the patients and physicians are left in the dark and neither the right hand nor the left hand knows what the other is doing. And the insurance folks capitalize on this ignorance. Just like you, Dr Everest I also believe that education is the key. But are we willing to do what is required as healthcare providers for our patients…… and as patients ourselves?

    How do I know that this will work? When I was at Sibley Hospital, a few years back I realized we were bleeding financially so badly that a heart bypass surgery would not have solved the catastrophic monthly losses. I decided to take on the biggest bad wolf of the pack among the insurance companies and decided to befriend them. What do I mean by that? I learned everything I could about them. I mastered all their policies in and out. I also got to know the players behind the scenes. And I became so good at it that I sometimes spent 30% of my time debating with the insurance about denials. I won each and every time!!! Never lost one. And eventually we had a ZERO denial in one year for that insurance company.

    Education is the key to mastering this seemingly impossible legal and political maze. The insurance companies are counting on our collective refusal to be bothered with the details…..and that why they literally get away with murder everyday. I hope for the day when physicians and care providers take back their right to decide what a patient should nor should not receive as treatment. We unwittingly gave this right to the insurance companies – we are the only ones who can take it back – with education and consistent effort.

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