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A Love Letter to Our Favorite Payers


The current state of our relationship is an illogical, Kafkaesque nightmare with a deadbeat. Yes, we're talking about you, payers.

This past Valentine's Day, we reflected upon the health of our relationship with payers. It's not a pretty picture. To shield patient protected health information and try to salvage any goodwill we may possibly have left with any of these payers, we have used only pseudonyms in the examples below.

Let's consider first our relationship with the Star Trek Insurance Plan, they are known for embracing only the most illogical of logic found within our industry. In the past year, one problem with them included not paying for a basic well exam because they claim our practice wasn't listed as the patient's primary-care provider (PCP). When we presented evidence of the fact that no other PCP has ever seen this child and we have been the only pediatrician for the child since her birth four years ago, and that we had a signed, dated form supposedly utilized by this plan for the purpose of communicating to the plan when an error in assigning PCP has been made, they gave us the cold shoulder. They refused to respond to any written or verbal appeals. One time, Star Trek Insurance Plan even hung up on us when we tried to speak with them about the issue. That time, we ended up turning to social media to publicly shame them into returning a call. Illogical.

Next, let's talk about Deadbeat Insurance, Inc., a company that gives new meaning to the phrase, "The check is in the mail." In March of 2016, we provided preventative services to a longstanding patient. On the insurer's website, as early as two weeks after the date of service, we could clearly see that the plan had processed the claim and acknowledged that payment was due to our practice. However, the payment had yet to come. There was no payment in April, so we called. We wrote. Deadbeat Insurance Plan did not respond. We called and wrote again in May, June, July and August. On the phone, their representatives would only say, "It's pending. Don't know why." By October, when there was still no payment, we involved our independent physician's association who reached out to a "senior" person at the plan. That senior person assured us we would be paid. We weren't. We contacted him again in November. Still no payment. December and January also went by with more emails and calls until this month, nearly a year later, when we were paid.  Deadbeats.

There are countless other examples. There's the insurance company that, out of nowhere, decided that patients must pay an extra $10 copay if the patient sees us for chronic anxiety, a common pediatric issue they didn't charge extra for in the past. Several of the payers illegally pass on charges to patients that are defined as preventative by the Bright Futures part of the Affordable Care Act. Don't even get us started on the inability of insurance companies to acknowledge that twins, who have the same last name, date of birth and sex, are separate children and that their claims are not duplicates of each other. It's a Kafkaesque nightmare.

We want to end this abusive relationship with payers, and know that some of you have done this with direct pay. In our community, most our patients would never be able to afford the out-of-pocket costs associated with direct pay, so our personal ethics make us put up with our insurance bullies and do all we can to work toward single payer.

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