I don’t know the insinuation here (are we blaming hospitals/doctors? Are we saying the system is broken? Both?) The reality is that this construct has been around since the 1950s. Insurers designed deductibles to make sure that patients had skin in the game. The thought is that if patients don’t pay anything, patients will overutilize care. The concept was taken from other insurance products (like auto insurance) A wrinkle in the system that many don’t think about is that a third party, the physician or hospital delivering care, must stop their normal activity of delivering care to ask the patient for money. The physician or hospital didn’t design the plan, didn’t set the deductible/copay/coinsurance, and generally is an innocent bystander. But, the insurer makes the physician or hospital do their dirty work because the insurer AUTOMATICALLY removes the patient owed amount from the amount they pay a doctor. What does that mean? That means a part of a doctor’s paycheck requires them to ask for money from the patient they are supposed to be focused on treating, introducing frustration and distrust into the physician-patient relationship. Maybe this was a sound idea when the amount patients had to pay was small, but that’s not the case anymore. 75% of Americans have an out of pocket of at least $3,000. High deductible plans are increasing every year. Why? Because insurers have encouraged employers to continue to increase out of pocket amounts to keep insurance premiums down. Don’t want to pay that double digit premium increase next year? Just increase that deductible/copay/coinsurance and your premium will only go up a little bit. Here’s a little secret… the majority of patients never meet their deductible. Why is that important? Because that means that despite all those sky high premiums you paid, you still paid for every dollar of your own care. The average family pays (in combination with their employer) $27,000 per year but they, on average, get nothing back out of that money they spent. Today’s premiums are high, in large part, due to massive consolidation and corporate greed. Doctors got tired of telling their patients to pay them money, of tracking down prior authorizations, and all the other tricks insurers use to make sure patients pay every dollar of their care after premiums and the insurer never pays a dollar. Meanwhile both insurers and the federal government have paid doctors less to do more. Just with Medicare alone, doctors are at half of what they should be paid if they kept up with inflation since 2000. Private insurers seized on the governments reductions and similarly ratcheted down payments. Doctors have left private practice in droves into the arms of hospitals and insurers who have seen record profits as they both consolidate into national behemoths. The system is working exactly as it was designed… to give a few large organizations substantial profit margins. When doctors try to collect those amounts, they are called greedy. When they go out of network, they are called greedy. When they ask for increases in pay consistent with inflation, they are called greedy. Is it any wonder they now go to those same hospitals and insurers and ask for a salary with production based incentives now instead of openly asking for more pay in a public forum? Let’s write the real stories in the papers, not just surface stories about the symptoms of a sick healthcare system that has been invaded by insurers, hospitals, and government interests.

Thank you… The IDR process was a backstop. It is utilized for 6% of all claims. That sounds like a backstop There are bigger fish to fry. Amazing how organized everyone gets the first time doctors get a win in healthcare

The number of bids at or below $1 aren’t just alarming. They are accelerating. In early 2023, $1 or less bids were 2.5% of all claims. By 2025 Q2 that number was 12.5%. Why are insurers bidding less every quarter? Why don’t they value the services physicians render? Read more detail here: indemed.org/whats-your-care-…

It just amazes me how little insurers are willing to pay for life saving care. How are they providing value? By literally not paying for life saving care?

Let me understand this…. A doctor performs a life saving intubation and they don’t even deserve $1? I mean the Starbucks employee at the lobby coffee shop got more in a tip for making a venti iced caramel macchiato, blond espresso, oat milk, three pumps vanilla, two pumps caramel with vanilla sweet cream cold foam.

Insurers have shined the light on doctors who they feel bid extravagant amounts for their services. When the arbitrators agree with that claim, they cry foul. I love that IndeMed is now highlighting some of the absurd values insurers have placed on lifesaving care. Critical newborn care…. That’s worth $0? Well it is according to an insurer.