Medicare insurers not paying, doctors complain to AMA

The House of Delegates also dealt with Medicare issues from payment cuts to balance billing.

By Joel B. Finkelstein, AMNews staff. July 7, 2003.

Chicago -- It's hard to make much money off Medicare, but physicians say health insurance companies have figured out one way: Stiff patients and their doctors.

The problem is with secondary insurers, AMA delegates said at last month's Annual Meeting. Beneficiaries pay into these plans on top of paying their regular Medicare cost sharing. The trouble is, they aren't getting any benefit from the extra spending, physicians said.

Some of these insurers are telling physicians that because Medicare reimburses what the plan would normally pay for a service, they do not have to pay anything for that care.

The physicians argue, however, that patients are paying the plans a premium and should get some benefits for their money. They passed a resolution calling for the AMA to push for legislation requiring secondary insurers to reimburse toward patients' deductibles or co-pays as much as the insurer would have paid for any other plan member. The resolution specifies that the problem is not related to medigap plans.

The companies are "getting a terrific windfall by not providing insurance," said John A. Ostuni, MD, an internist from Freeport, N.Y.

Frederick L. Merian, MD, a family physician from Victoria, Texas, described it as Insurance 101: Collect insurance premiums and don't pay out anything.

Doctors in Michigan are seeing a similar problem with one of their insurers, said Alan M. Mindlin, MD, an ophthalmologist from Pontiac. He said he hoped the loophole was closed before other insurers decided to adopt the strategy.