Letters to the Editor - June 13, 2005

Insurance should reimburse patients and not be a concern for physicians - Health care system will work better if patients are forced to confront costs

Insurance should reimburse patients and not be a concern for physicians

Regarding "Out of network, out of luck: The perils of breaking the tie" (Article, May 16):

I'm constantly amazed at how physicians allow themselves to be pushed around and bullied by insurance companies because they refuse to get involved in the dirty word "money" part of the patient care. That's the part where you get paid for your time and experience.

If the insurance company wishes to send the check to the patient, great. After all, it's the patient's insurance contract, not mine. That's what my auto policy did when I had a claim, and I did have to pay cash for the repair before getting reimbursed about three weeks later.

I'd encourage every physician who reads this letter to do the obvious thing and have the patients pay their service charges on the day of service, or at a bare minimum, guarantee them with a credit card or an alternate financing agreement. If you are too afraid to do that, then you deserve how you are getting treated. The insurance industry continues to undermine the physician-patient relationship, and physicians are not under obligation to treat people for free, or at someone's "approved" rate.

I'm out of network, and my patients pay my office charges. I see fewer patients a day, give them better service and set my own fee schedule. Don't be fooled by the insurance industry. You don't need them. They need you!

If patients have insurance coverage, great; if they don't, they simply save my superbill for tax purposes. My financial agreement is with my patient; any insurance contract they have is their business, not mine. Come on, people, toss off the insurance baggage. It's a whole new world out there!

--Gary Page, MD, Layton, Utah

Health care system will work better if patients are forced to confront costs

Regarding "Out of network, out of luck: The perils of breaking the tie" (Article, May 16): This article basically points out how insurance companies are trying to force physicians to remain in, or return to, their networks by sending the reimbursement checks to the patient rather than to the out-of-network physician.

I empathize with Jim Palombaro, MD, of Raleigh, N.C., a physician quoted in the article, and agree that this is unfair in the present health care environment. But I disagree with his statement that "you don't need to have the patient in the middle of this."

The main problem with our health care delivery system is that the insurance companies are in the middle of the system when it should be the patient! One of the primary reasons health care costs are soaring is that patients never see the bill and have no economic incentive to be cost-conscious in a system that does not operate under free market economic principles like everything else in our society.

Perhaps we should return to 25 years ago, when the insurance contract was strictly between the insurance company and the patient. Physicians charge their usual and customary fee, and the patient pays the fee. I think that is how the rest of society functions. If a physician gets out of line with their fees, then I suspect patients will figure this out.

Patients must take more responsibility in our new health care delivery system, and they will if we give them the opportunity to do so. Our reimbursement mechanisms have become untenable in the present system because physicians have no market power due to one-sided antitrust laws that need to be changed (that's another topic for another time).

--Jeff Terry, MD, Mobile, Ala.