{"id":8019,"date":"2013-03-18T20:00:36","date_gmt":"2013-03-19T00:00:36","guid":{"rendered":"http:\/\/blog.carecloud.com\/?p=8019"},"modified":"2025-06-30T17:50:20","modified_gmt":"2025-06-30T17:50:20","slug":"whats-wrong-with-health-insurance-payments","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/whats-wrong-with-health-insurance-payments\/","title":{"rendered":"What\u2019s Wrong With Health Insurance Payments?"},"content":{"rendered":"

If you\u2019ve ever practiced medicine in the U.S., it\u2019s almost certain that you\u2019ve had problems collecting from insurers. Chances are they didn\u2019t pay you enough for your services, or possibly not at all.<\/p>\n

The numbers, however, tell a different story. The privately insured healthcare market in this country is enormous.<\/p>\n

Americans now spend $7,000 per capita on health care every year<\/strong>, and these numbers are growing at an average annual\u00a0rate of 6.5%.<\/p>\n

So if insurance are getting paid all that moolah<\/em>, why is it such an issue for doctors to collect a fair payment?<\/p>\n

Price Negotiations
\n<\/strong>Unlike the Medicare market in which CMS standardizes payments to providers, most private-sector insurance payments are determined through negotiations between insurers and providers.<\/strong><\/p>\n

Insurances hold the upper hand during these negotiations as they hold the clout of millions of dollars of spending power in their back pockets.<\/p>\n

The prices health plans negotiate with in-network providers have little or nothing to do with the actual quality of services provided and everything to do with the relative bargaining power of insurers.<\/p>\n

This system, along with having to make up for charity care, debts they can\u2019t collect, and inadequate reimbursements from government Medicare and Medicaid programs, forces providers to charge skyrocketing amounts for treatment.<\/p>\n

Also, due to contract negotiations, hospitals have to charge patients different amounts for the same equipment and procedures, depending on their insurance carrier.<\/p>\n

\u201cIf we could have fixed this, we would\u2019ve,\u201d said Rich Umbdenstock, president of the American Hospital Association. \u201cWhy would we want to perpetuate this?\u201d Stories about people facing insurmountable bills are \u201cone of the toughest PR issues we have\u201d and damage the industry\u2019s credibility, Umbdenstock said.<\/p>\n

While \u201chospitals are not victims,\u201d he said, \u201cwe are caught up in a larger system.\u201d Unfortunately for some uninsured Americans, it\u2019s a \u201ccrazy system.\u201d<\/p>\n

Who pays the price?
\n<\/strong>The 48.6 million uninsured Americans<\/a>, that\u2019s who. Without the bargaining power of insurances, this portion of the population is forced to pay astronomical prices for medical expenses.<\/p>\n

So-called full charges at hospitals grew an average of 10 percent a year<\/strong> between 2000 and 2010, according to Gerard Anderson, a Johns Hopkins University professor who analyzes hospital financial reports. The charges went up at four times the pace of inflation, and faster than hospital costs, which Anderson said increased an average of 6 percent a year.<\/p>\n

The system is so irrational that those without insurance can get stuck owing the most money, said David Himmelstein, a professor at City University School of Public Health at Hunter College in New York.<\/p>\n

\u201cIt\u2019s unconscionable,\u201d said Himmelstein, who co-authored a 2009 study that found illness and medical debt was a factor in six out of every ten personal bankruptcies. \u201cIt adds to the already grave suffering of the uninsured.\u201d<\/p>\n

Private practice doctors take the second biggest hit from insurance price negotiations.\u00a0 The sad truth is that family physicians, cardiologists and even oncologists are going broke from underpayments by insurances.<\/p>\n

Half of all doctors in the nation operate a private practice, so if a cash crunch forces the death of an independent practice in a small town, it deprives the community of a vital health care resource.<\/p>\n

Doctors now list shrinking insurance reimbursements, changing regulations, rising business and drug costs as the leading factors preventing them from keeping their practices afloat.<\/p>\n

The Solution
\n<\/strong>As some health plans have already begun doing, all insurers should set their payment rates at a percentage of what Medicare\u00a0pays for medical services.<\/p>\n

A March 2012 investigation by the New York State Department of Financial Services found that most private insurance plans that use this method pay between 110 percent and 150 percent of what Medicare pays.<\/p>\n

This is what many consider to be a fair deal.<\/strong><\/p>\n

Because of Medicare\u2019s size\u00ad, it pays the biggest portion of the nation\u2019s health-care bill than any other single entity. It has the ability to set prices without negotiating with doctors, and these \u201cfee schedules\u201d are established at a government-regulated percentage of what providers charge.<\/p>\n

If all insurances were to align medical payments with Medicare, it would level the playing field and turn out beneficial for almost everyone involved. Patients would not receive massive bills out of the blue and providers could set fixed prices more accurately.<\/p>\n

Insurances would probably take the biggest hit in their profits. But with the average insured worker paying almost $16,000 on health insurance in 2012, I don\u2019t think they\u2019ll be hurting too much<\/a>.<\/p>\n

We\u2019ll see which way the landscape of health insurance payments shifts over the following years with the implementation of the Affordable Care Act<\/a>, where more than 32 million uninsured Americans will receive coverage.<\/p>\n

How do you feel about private health insurance payment negotiations? A fair deal for doctors: yay or nay?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

If you\u2019ve ever practiced medicine in the U.S., it\u2019s almost certain that you\u2019ve had problems collecting from insurers. Chances are they didn\u2019t pay you enough for your services, or possibly not at all. The numbers, however, tell a different story. The privately insured healthcare market in this country is enormous.<\/p>\n","protected":false},"author":1,"featured_media":32785,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-8019","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-growth"],"yoast_head":"\nWhat\u2019s Wrong With Health Insurance Payments - CareCloud<\/title>\n<meta name=\"description\" content=\"If health insurance plans are getting paid millions in premiums, why is it such an issue for doctors to collect a fair payment?\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carecloud.com\/continuum\/whats-wrong-with-health-insurance-payments\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What\u2019s Wrong With Health Insurance Payments - 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