Discover the Best Consultancy Bill Format in Word for Healthcare

Consultancy bill format in word for Healthcare

after Brian Thompson the CEO of United Healthcare was killed in New York City we saw a huge outpouring of anger directed toward health insurance companies the vitriol and the scale of the response was shocking to many we wanted to hear from doctors who deal with patients and insurers on a day-to-day basis have you been surprised by the response I think I have and I haven't I mean I certainly feel the undertones from my patients the anger at my staff that they can't do something right away but surprised at the amount of support there is uh for obviously something that's inappropriate and shouldn't have ever happened I'm not surprised to be honest I'm not always able to give my patients the care they need what is the worst thing you have to deal with from an insurance perspective the worst thing that we have to deal with from the standpoint of the patients is pre-authorizations prior authorization means that the insurer has to approve whatever medical procedure that your doctor thinks you need nearly all doctors surveyed by the American Medical Association said that prior authorization requirements have delayed access to necessary care something that pretty much didn't even exist when I started practice decades ago instead of us being able to spend time in the office with our patients we're wasting that time with insurance companies now we have entire teams dedicated just to the non-clinical administrative side of our practice that wasn't there when I started 10 years ago and another pain Point can come after the care is rendered sometimes the care is given and then the insurer decides in retrospect perhaps that it wasn't Justified or it doesn't fit the plan and shouldn't be paid for so what we see in healthcare workers is people get demoralized people leave the business it's a huge financial and uh emotional burden and it can impact a patient's care one in four doctors said that prior authorization led to a serious or life-threatening medical issue I had a patient she had history of breast cancer she had a double mastectomy several years later she started getting pain in her chest and the appropriate test for her unquestionably was a CT scan I ordered the test it was denied by her health insurance company it was a delay until she actually got the test she needed it showed a recurrence of cancer and the patient later died this is a stark example but not an uncommon example of what happens it's not always a discussion just between me and the patient as it should be it's an insurance company getting involved and deciding that the care that I think is necessary the care that the patient thinks is necessary is not necessary is there a specific point you can trace back to when things started getting worse certainly the expansion of Medicare Advantage is has made a massive difference for us Medicare Advantage when private companies administer publicly funded insurance has expanded widely more than half of all eligible people now have one of these private plans with traditional Medicare there's essentially no prior authorization when Medicare Advantage takes over now we introduce significant prior authorizations these private for-profit insurers that run Medicare Advantage they are absolutely in a league by themselves and the denials are to my mind completely capricious data shows that Medicare Advantage insurers denied about 7% of prior authorization requests ing to a 2024 Senate report denial rates were much higher when it came to things like Rehab and posttop Care The Wall Street Journal has been investigating Medicare Advantage for the last year this year the journal has actually spent a lot of time looking at things that really aren't part of the front door that are kind of behind the scenes one of our stories looked at the prevalence of diagnoses in Medicare Advantage that did not actually come from a doctor treating the patient they actually were added to the patient records through activities associ iated with the insurer so to understand Medicare Advantage one thing you have to understand is that the insurers that work in Medicare Advantage uh are paid more if the person that they're covering has more health conditions so there's a strong incentive for Medicare Advantage insurers to document more diagnosis things like diabetic cataracts or morbid obesity it doesn't mean those diagnoses aren't true but there is a greater payment for the insurer if they document more diagnoses insurer driven diagnoses in 2021 generated $8.7 billion in payments for United Healthcare and that was the most in that year of any insurer in response to the journal's previous reporting United Health has said that Medicare Advantage provides Better Health outcomes and more affordable health care for millions of seniors when reached again for comment they pointed us to recent changes the company has made to streamline the prior authorization process America's health insurance plans an industry trade group said in a statement to the journal that providers and Drug makers also share in the responsibility to patients and that health plans work to protect patients from rising costs so I think insurers are do see themselves and it is true as one of the few players in the system whose job is to try to Tamp down those costs however the costs continue to rise I think it's important that there are checks and Balan is the real problem is that what was intended to be a nice check and balance has turned into a way of penalizing Physicians and patients in order to increase profits for shareholders the universal feeling is that insurance companies are working against us against what we want for our patients what our patients need