Many of you have emailed or called asking about E.D. Hill's recovery from surgery and we're happy to let you know all has gone well and E.D. will be returning to Good Morning with E.D. Hill Tuesday February 23, 2010 at 8A EST only on www.americaswebradio.com. If you'd like to ask E.D. any questions feel free to email gm@americaswebradio.com and we'll ask the questions Tuesday.
I'd like to take this space to thank E.D. for doing her show and thank you for listening and passing on the information about the station your loyal support is greatly appreciated by www.americaswebradio.com and we also want to thank our sponsors and invite you to join our family if you have a business or organization that would like to be a part of what we're doing.
Thank God for the net and the wonderful hosts we have in our continuing efforts to balance the truth with the fiction from major media. What would happen to freedom of speech if we didn't have the net?
6 Ways Your Health Insurance Company Makes It Hard For Your Doctor To Take Care Of You
By: Dr. Elaina George
There is a major misconception about the reasons for the rise in the cost of healthcare. Procedures and the practice of defensive medicine have been described as the main reasons for the exponential rise. However, the reality could not be farther from what is portrayed on TV series like Nip/Tuck. The medical insurance industry has fueled the campaign of misinformation to enhance their divide and conquer strategy. As long as people spend their energy on blaming doctors, they have less energy to pay attention to rising deductibles, premiums and co-insurance. In short, the insurance companies benefit by keeping doctors and patients at odds. In reality when a doctor charges for a procedure or performs a surgery what is paid is no where near the amount that was charged. In short, the increase in patient premiums, deductibles etc… have gone to pay administrative costs and CEO salaries.
These are 6 things you need to know so you can understand the barriers your doctor has to navigate to take good care of you:
Insurance companies change what they will pay for
Through the pre-certification process, insurance companies will change what services they will reimburse. This list can change yearly. It is driven by insurance company costs and not by medical necessity as determined by the doctor and the patient.
Insurance companies have gatekeepers that look for reasons to deny recommended services
Insurance companies have physicians and/or nurses on staff that can deny services. The person that reviews the procedure may not even be someone familiar with the medical procedure (for example, a psychiatrist reviewing the records of a surgeon).
Insurance gatekeepers get bonus compensation when they save the company money
This is pretty self explanatory – it pays to deny care.
Insurance companies discount payments for surgery and other procedures.
This is a process called bundling. If the procedure has a left and right side like knee surgery or has several steps. like sinus surgery, the surgeon will be paid a steeply discounted rate that can be as high as an 80% discount. For example, a surgeon will be paid the discounted insurance allowed amount for the 1st side and 50% for the second side. If it is a multi-step procedure, the surgeon will be paid the allowed amount for the 1st step, 50% for the second step and 25% for 3-5th step then nothing for anything beyond the 5th step.
5.Insurance companies make a bigger profit by delaying payment to doctors
A study showed that an insurance company can make as much as $84,000 in bank interest rates each day they pay
a claim late. By law an average clean claim (with no errors) should be paid from 14-30 days after it is submitted
by a doctor’s office. The average claim is paid anywhere from 30-45 days. Some claims, after multiple appeals,
can take up to a year to be paid after the service was given.
6.Insurance companies can ask the doctor for reimbursement of paid claims indefinitely.
A doctor has 120 days to submit a claim, after that time he/she may not submit a charge or charge the patient. However, an insurance company can ask for reimbursement with no time limit.
As the health care issue continues to heat up we continue to present different sides of the story with our host interviewing interesting folks from around the country in one way or another involved in the discussion. And, we'd like to hear from you.
Medicine on Call with Dr. Elaina George has Jason Rosenbaum, Editor of the Seminal and contributor to the Huffington Post as her guest today. Tune in to Dr. George as frankly many direct question will be presented for discussion and issues concerning the potential Universal Health Care Program will be addressed like funding.
twitter Dr. George @medicineoncall and always listen to her show at 9 AM EST only on www.americaswebradio.com and www.radiosandysprings.com your chat radio station. Email questions welcomed at drgeorge@radiosandysprings.com or gm@radiosandysprings.com.
