{"id":6203,"date":"2014-03-10T07:25:10","date_gmt":"2014-03-10T12:25:10","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=6090"},"modified":"2021-09-12T22:30:56","modified_gmt":"2021-09-13T03:30:56","slug":"we-want-you-to-die","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2014\/03\/10\/we-want-you-to-die","title":{"rendered":"We Want You To Die"},"content":{"rendered":"\n

It\u2019s funny how the mind works. You find yourself in a particular situation and as you mull over what to do, all of a sudden up pops a line from a movie. Good old Freud, always reliable when it comes to mining your subconscious.<\/span><\/p>\n\n\n\n

The question, from the aliens-invade-earth action flick Independence Day, is posed by the US president to a decidedly uncuddly ET<\/a>, whose response is chilling.<\/p>\n\n\n\n

\u201cWhat is it you want us to do?\u201d
\u201cDie!\u201d<\/p>\n\n\n\n

You probably saw the movie. Vicious aliens brutally attack Earth, destroying city after city, zapping millions of innocent people with their WMDs operated from flying saucers. I thought it endearing the way their weaponry ran on Windows. Either they\u2019d tapped into our systems or, possibly, Bill Gates was an alien.<\/p>\n\n\n\n

Now, though, it\u2019s the mephitic maw of the health insurance industry that opens, that same threatening line roaring out. In this scenario, Earthlings are represented by the rapidly declining number of primary care physician offices around the country, their bewildered patients casualties as well. I can only report first-hand on what Blue Cross of Illinois is doing to us at WholeHealth Chicago, but from what I\u2019ve been reading in the New York Times<\/i> and Medical Economics<\/i>, what\u2019s happening to us is pretty much a national phenomenon, with all insurers blasting away at all primary care offices.<\/p>\n\n\n\n

Because this affects you, the patient, and how your medical care is changing, I urge you to read all the way through today.<\/p>\n\n\n\n

ACA brings major changes<\/b><\/h3>\n\n\n\n

Everyone knew the Affordable Care Act<\/a> (ACA) would bring big changes to the health care delivery system. Some months ago, I reported on a talk given by a Blue Cross medical director<\/a>, breaking the news to a roomful of depressed doctors that their fee-for-service system was doomed because insurance companies could no longer afford to pay for health care under the PPO model. Their plan? Phase out all fee-for-service care during the next few years, replacing it under the ACA with low-cost care standardization.<\/p>\n\n\n\n

And with this, the once-inalienable right of patients to get–and doctors to provide–whatever care they needed (tests, specialists, medical equipment) was history. Essentially, the insurance industry now calls the shots. And while for the past 25 years the insurance industry has always been an extremely powerful player in how medicine is practiced (best documented in Michael Moore\u2019s film Sicko), never have all physician day-to-day decisions been so closely scrutinized for cost as they are now.<\/p>\n\n\n\n

The medical director went on to tell us that small practices with a mainly PPO patient base would likely be unable to tolerate the reduced physician fees planned under the ACA, and that these practices would gradually be acquired by large medical centers. This didn\u2019t mean a small medical office would close up shop completely. Instead it would become \u201ca Division of\u2026\u201d with the doctor a salaried employee of the larger entity. When hundreds of physicians and thousands of hospital beds are all controlled by one system (e.g., Northwestern, Advocate, Resurrection), everything is standardized and insurance companies like that. <\/i>Fees for every possible test and procedure would be pre-negotiated between medical center and insurance company. The medical centers would be financially rewarded with increasingly favorable reimbursement rates if patient care met certain quality standards, set by committees made up of medical center and insurance company employees.<\/p>\n\n\n\n

Here\u2019s an example of the inherent danger in this. If one of the reimbursement objectives is to ensure every patient\u2019s cholesterol is low, your prescription for a statin will be based not so much on your well-being as on the bottom-line improvement of the medical center. And if you don\u2019t take the statin and your cholesterol remains high, you\u2019ll be targeted as an undesirable non-compliant patient, actually affecting the financial bottom line of your doctor\u2019s group.<\/p>\n\n\n\n

As I write this, large medical centers are absorbing one practice after another, a mad scramble to accumulate as many warm bodies as possible in order to negotiate the best rates with insurers.<\/p>\n\n\n\n

End of the individual PPO<\/b><\/h3>\n\n\n\n

In the final months of 2013, virtually all of you who had individual PPO plans received a letter that terminated your coverage and advised you to buy health insurance under the ACA. When you attempted to do so, you found yourself paying a lot more for a lot less. I explained to surprised patients that they\u2019d been buying a product\u2014the PPO–that their insurer hated to be selling because it usually lost money on each enrollee. Why do you think they spent so much time ferretting out pre-existing conditions? Because anyone with PPO coverage who had just about any medical problem was a money-loser for them. On the other hand, employee group PPOs continue to survive because the insurance companies figure if you\u2019re well enough to go to work every day, there can\u2019t be too much wrong with you and you won\u2019t be a loss for them.<\/p>\n\n\n\n

Having terminated individual PPO enrollees and escalated charges on employee group PPO members, we\u2019re now nine weeks into the ACA and it\u2019s apparently time for insurance companies to scrub the US clean of the costly individual primary care office. They really don\u2019t want us closed in the sense of boarded up–I mean, they do acknowledge the US will need a few doctors out in the trenches–but they want us under the control of one of the major medical systems.<\/p>\n\n\n\n

Make no mistake. The health insurance industry wants the likes of WholeHealth Chicago on a short leash. (\u201cNutritional counseling?! Just give them a goddamn statin and tell them to stop whining.\u201d)<\/p>\n\n\n\n

No matter how much they want primary care PPO physicians to disappear, however, health insurance companies recently discovered they can\u2019t simply terminate contracts with physicians via a letter that says \u201cThanks for your service over the past 20 years. Things have changed and it\u2019s hasta la vista<\/i>, baby.\u201d UnitedHealthcare attempted this with 2,250 physicians in Connecticut and got blocked by a court order<\/a>.<\/p>\n\n\n\n

But what an insurer can do is make life so thoroughly miserable for physicians that they leave voluntarily, selling their practice to one of the Big Boy Medical Centers.<\/p>\n\n\n\n

Making your doctor\u2019s life hell<\/b><\/h3>\n\n\n\n

The easiest way to make life miserable for a medical group is to set up systems to delay payment for services already rendered. This is done by generating scads of unnecessary procedural paperwork. United, Humana, and Cigna are past masters of this tactic, Cigna setting a new record by being 14 months in arrears. Patients can\u2019t fathom this. I tell them, imagine you\u2019re the proprietor of a restaurant or a hair salon or a toy store. In January, 2012, in walks a customer, takes your product, and says \u201cYour check will arrive in March, 2013.\u201d<\/p>\n\n\n\n

This, by the way, is why WholeHealth Chicago avoided being in network with these villains. Patients often asked, \u201cWhy aren\u2019t you in network with such-and-such an insurance company?\u201d Quick answer: \u201cWe\u2019ve got rent and a payroll to meet. We need a cash flow to survive.\u201d<\/p>\n\n\n\n

Blue Cross of Illinois, since it\u2019s both non-profit and originally founded by physicians, was always more reasonable, paying fairly promptly and keeping unnecessary paperwork to a minimum. But with the ACA, times have changed. Their CEO is currently paid $16 million a year (never knew not-for-profits were so profitable, did you?), they too want to keep as much money as possible for themselves, and, like everyone else, want docs out of the fee-for-service model. So Blue Cross has joined the ranks of egregiously slow payers.<\/p>\n\n\n\n

To delay payment to a doctor, <\/i>an insurer–any insurer–seeks out potential violations in something you\u2019ve never heard of called a \u201cprovider manual.\u201d This is a document so immense that no living human has ever actually read one. I once went online, hunted it down, and guessed it at about 1000 pages of rules and regulations.<\/p>\n\n\n\n

Here\u2019s an example of how they delay a payment. Let\u2019s say I order a vitamin D level for you. Since low vitamin D is now associated with umpteen diseases (from cancers and heart disease to autism) and Chicago is singularly unsunny, vitamin D deficiency is very common. The journal American Family Physician<\/i> recommends vitamin D be included in health screening tests. An insurance company, however, might allow your in-network physician to measure vitamin D levels only when diagnosing an illness and not when screening for low vitamin D.<\/p>\n\n\n\n

So when our reimbursement check for physician services and labs <\/i>we provided for you arrives, payment for the vitamin D level is conspicuously absent. Instead, they send us a form letter asking some questions:<\/p>\n\n\n\n

(1) you money-wasting quack, why did you order that ridiculous test?
(2) as long as you did order it, what was the result?
(3) to make sure you\u2019re not trying to cheat us, copy and send the chart notes from the day you ordered the test.
(4) let\u2019s see what you did with the test results–send us those notes, too.
(5) and then, when we\u2019ve got everything, we\u2019ll give some thought to paying you, but don\u2019t get your hopes up.<\/p>\n\n\n\n

Language of their letter slightly altered (but not much) to capture intent.<\/p>\n\n\n\n

Gathering all this data takes an enormous amount of a doctor\u2019s staff time (insurance company grins lewdly at the thought), keeps the doctor\u2019s staff from doing its usual job (insurance company laughs obscenely), and when the documents finally arrive at the insurer, with a hearty Rabelaisian or Chaucerian guffaw the meticulously collected correspondence is tossed unceremoniously <\/i>into a \u201cTo Do\u201d bin, where it may languish for months.<\/p>\n\n\n\n

In 2013, I wrote about 50 (yes, 50) <\/i>letters regarding reimbursement for food sensitivity testing. After six months of silence, I called and was told (god\u2019s honest) \u201cOh, we wondered why those letters kept arriving. We didn\u2019t know what to do with them.\u201d And in three weeks, reimbursement for all 50 was summarily denied.<\/p>\n\n\n\n

What routinely happens after this \u201cdelaying documentation\u201d is returned to the insurer is that after some weeks, when your doctor\u2019s billing department calls about the claim status, the robotic answer is \u201cWe\u2019re still working on it.\u201d Cigna\u2019s specialty was to say the paperwork never arrived, but then adamantly refuse to provide a fax number. To be honest, after decades running a small office, these deliberate payment delays come with the territory. For years we\u2019d receive a handful of delays each month and just deal with them, the way a small shop owner deals with the occasional bad check.<\/p>\n\n\n\n

But not paying for services rendered is theft, pure and simple. Are health insurers actually thieves? Just ask the Medical Society of the State of New York. When physicians in New York state realized UnitedHealthcare had been deliberately underpaying them for years, they took the case to court and won a settlement of $350 million<\/a>.<\/p>\n\n\n\n

Then came the ACA, with its planned extinction of small private medical offices. Ready for this?<\/p>\n\n\n\n

Swamped with letters<\/b><\/h3>\n\n\n\n

Last week alone, an avalanche of 30 letters requesting \u201cfurther documentation before payment\u201d arrived at WholeHealth Chicago. So our doctors and billing clerks sat down and set up a system to answer them efficiently. Then, on March 6, 2014, the morning mail came in a bag, 76 letters in a single day. Here\u2019s a photo.<\/p>\n\n\n\n

\"BC.BS<\/a><\/figure>\n\n\n\n

If that’s not bizarre enough, these latest \u201crequests for further documentation\u201d include such sentences as:<\/p>\n\n\n\n

\u201cWhy did you order orthotics (shoe inserts)?\u201d when none had been ordered.<\/p>\n\n\n\n

\u201cWhy did you order anesthesia?\u201d when the patient came in for a thyroid check and was never anesthetized.<\/p>\n\n\n\n

\u201cWhy did you order a TSH (thyroid-stimulating hormone)\u2026or vitamin D\u2026or cortisol test?\u201d<\/p>\n\n\n\n

Of course you\u2019d like to call someone at Blue Cross and ask \u201cWhat gives?\u201d But there\u2019s no signature on the letter. The 800 number is just the main Blue Cross phone line and utterly useless. And it\u2019s not just us. According to our physician and chiropractic friends, everyone is being swamped with these letters.<\/p>\n\n\n\n

If the insurance companies were honest, we know what they\u2019d say in answer to the question \u201cWhy are you doing this?\u201d They\u2019d respond (straight out of the alien from Independence Day), <\/i>\u201cWe want you to die.\u201d<\/p>\n\n\n\n

My next Health Tip will discuss how these changes affect patients. On the one hand, the days of a lengthy office visit with a doctor who\u2019s known you for years for a $20 co-pay are drawing to a close. The ACA will bring in far more patients than the current system can handle, even with all doctors working at energizer bunny speed.<\/p>\n\n\n\n

On the other hand, Dr. Rubin and I founded WholeHealth Chicago on one underlying principle: that we\u2019d never place ourselves under time constraints with our patients. If a patient arrived with a list of problems, the visit wouldn\u2019t end until every item was addressed. Unless this deliberate insurance company harassment stops, we may be compelled to throw in the towel and go out of network with Blue Cross.<\/i><\/p>\n\n\n\n

But here\u2019s a fact. Fully half of WholeHealth Chicago\u2019s patients are already out of network. And while they\u2019d rather we accept their insurance, we hope we offset that by providing all our patients, in network and out, an exceptional knowledge of integrative medicine, a broad variety of services, and an unhurried atmosphere. That\u2019s what our patients tell us makes coming to WHC worthwhile.<\/p>\n\n\n\n

You know what\u2019s coming next. If you work at your health by eating well, exercising, and so forth, you really won\u2019t need us much. In network, out of network, keep away from us and your health care costs should remain really low.<\/p>\n\n\n\n

We\u2019ll talk soon and, oh, stay well,
David Edelberg, MD<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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