Health Insurance Horror Stories

Provider Horror Stories

Here you can read about the experiences of other Health Care Providers. Perhaps as these stories are read you will become more committed to the need to correct the current health care system.

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Blue Cross sucks. I have never had what I would call a good experience in working with Blue Cross, of any state. They are all the same. They make providers take enormous discounts to become "particating", which you have to be to receive any payments. Then they hold payment on claims for as long as possible (if you can get them the claim, as after filing three times they still "cannot find it in their system"), and then deny claims until the provider gives up, as it is too costly to continue to fight with them. And we wonder why medical costs have skyrocketed?

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I want to share with other providers an article I wrote that was published in a local paper and maybe you can modify it to serve your purposes.

MANAGED CARE GOUGES THERAPISTS INCOMES

My legislators, ______, ______, ______, and _____have ignored my letters and phone calls regarding the way HMO’s and Managed Care Corporations have made doing business as a private practice psychotherapist very difficult. Things have become worse for employers who pay higher costs for healthcare coverage and for the insured who have less access to services. Not much attention has been given to providers who have faced cost of living and cost of business increases over the years occurring simultaneous to decreases in the amount we are reimbursed. I believe that legislation is the only way to remedy the problems of runaway market forces.

In 1980, I saw a therapist who had a profound impact on my life. I paid her $85.00 per session and my health plan reimbursed me 80%. Within 30 days of sending in my receipt, the health plan sent me a check for $68.00, making my out of pocket expense only $17.00. 23 years later, that very same health plan pays me as a “panel provider” only $68.00 per session. The amount I can earn has decrease from $85.00 to $68.00. Other HMOs and Managed Care Corporations pay $40.00 to $60.00 per patient hour. Ironically, since 1980, healthcare premiums have quadrupled in price.

Some more cost of living facts: In 1980, I paid a plumber $35.00 to fix my garbage disposal, and in 2003, I cannot find a plumber to do the same work for $100. In 1980, the cost of a Grand Slam Breakfast at Denny’s was $1.99 and today costs $2.99 that is up 30%. The cost for a family of four to go to Disneyland was $80 in 1980 and today it costs double at $160.00. My estimate indicates that it would take twice as much working time for a therapist to afford to take his or her family to breakfast and to Disneyland! But that is not all that has increased in Southern California. My auto mechanic tells me that in 1980 a good mechanic could make $6.00 to $10.00 per hour and nowadays earns $18 to $30 per hour. Statistics given by ewengin.com. say that “$50,000 in 1980 had the same buying power as $106,000 in 2002.”

Professional overhead costs have risen as well. Tuition for a Master’s Degree, at the same school I attended, was $2,800 per year in 1980 and today costs $15,810 per year. The typical office space today runs around $2.00 per square foot, around double from 20 years ago. Computers and ISP fees have come into existence. The new HIPPA law also requires significant expenses. We are mandated to take more costly continuing education classes to maintain licensure. Lawsuits by litigious patients have increased.

Things HAVE TO CHANGE and I suggest that legislators do the right thing and begin legislating changes such as upping our fees according to experience, decreasing the required costly continuing education units and require third party payors to reimburse us when we employ interns who work with clients. We need legislation that would allow county mental health contracted private practice therapists to make as much as an agency makes per hour when an intern sees a patient. In comparison, we currently get about 50% of that fee. Please create a law allowing for a billing code for the time it takes to do all the paperwork we are now required to do, a code to bill for the time we set aside for a patient when the patient does not show up and a code to bill payers for failure to reimburse us in a reasonable time. And please create legislation to eliminate blacklisting for therapists who might be what are labeled “high utilizers”.

Legislators, please help my profession by legislating changes so that we can take care of our families by earning what we should be earning. The changes I suggested would also ensure that potential therapists of tomorrow are not persuaded to go into other non-diploma careers that pay more. Please do not allow psychotherapists to be sold down the drain as your children and your children’s children can really benefit by what we have to offer.

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Hey, great site. I'm working on my first horror story.

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I am a mental health provider who has worked for many years with children. Over the last 2 years I have been working with a pediatrician to offer good but reasonably priced services for Attention Deficit Disorder. When I first attempted to get pre-certification for a modest amount of psychological testing I was told by the insurance company that the tests I wanted to use were not covered. When I asked what tests were covered I was told, "I'm sorry but you have to ask for a specific test and then we will tell you if we cover it". A classic catch 22 as I discovered they did not cover any of the tests most commonly used in ADD. So, your insurance covers services for ADD, just none of the tests or services used to treat the disorder. Welcome to managed care!

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I am the Physician-Director of the Women's Services Department at a major, local University student health center. We care for over 30,000 female college students. Two years ago, we saw a 20 year old student who was found to have a small, benign breast cyst. She was told to observe it and report back one month later. On her return visit, the cyst had disappeared. She had no subsequent visits or problems for two years. She applied to Blue Cross for routine health coverage. She honestly listed our health center as the last health care she had received. Pre-insurance records on her were requested by Blue Cross. They agreed to cover her, but wanted to "EXCLUDE ALL DISORDERS OF THE BREAST AND REPRODUCTIVE ORGANS" for 5 years! So, no Pap smears, no contraception, no breast checks and on and on for 5 years based on a simple cyst that lasted 1 month. She would have been better denying ANY prior health services, and never listing us. Blue Cross? DOUBLE CROSS seems more appropriate.

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Great site! We should send Emails to the health editors of every major newspaper, television and radio station and about this site. I'll cover the Email to stations and papers in my area. Keep up the good work. With luck, class action attorneys as well will find this a most palatable reference source.