Good Afternoon to all of our friends during this most unusual and threatening time period. I realize everyone is overwhelmed with the pandemic, but I need your help! I am asking anyone who reads our newsletters to call us and educate us on how we can hold the insurance companies accountable to their patients.
I will explain only one of the many cases that McDonald Physical Therapy (MPT) has seen throughout the last few years. This particular one seems so very unjust because we saved a patient from a scheduled back surgery and never got paid a dime! I realize many of our friends who are doctors have been frustrated with the same problems. Some doctors have retired early or left medicine all together because of the frustration in dealing with insurance companies, who, after the patients were better or on the verge of getting better, decided to refuse to pay for their services. Up until now, I believed there was no recourse. However, with the help of all the patients we know, I am hoping we will find the answer to hold these insurance companies responsible for their patients.
As an owner of a small company, I know the insurance companies have no problem increasing our rates 22-25% over one year! How is that possible? Can anyone of us in medicine or any other field for that matter, increase our charges 22-25% in one year? The answer is no for everyone except insurance companies. We, the employers, are forced to pay their exorbitant fees, and the employees and the medical providers are left with the bill because the insurance companies often refuse to pay for the services needed.
My first patient came into our office right after visiting a back surgeon on a Tuesday. This patient had pain down his leg with his foot dragging (We would call it a dropped foot). The husband and wife informed me that the surgeon changed his schedule to accommodate this serious nerve compression problem, and made plans to perform surgery on Thursday.
I asked why they came to see me? This person’s wife had been helped by us years ago and she was wondering if there was any way possible we could help her husband avoid surgery. I informed them that the surgeon was doing his job. Her husband had foot weakness, which meant the nerve was compressed and performing surgery quickly was a good thing. The back surgery would help this patient regain his foot strength.
The patient’s wife and the patient were not totally convinced and wanted a second opinion. I told them of another surgeon who I believed would give them the same news. They asked if there was any way I could get in touch with him to help them make their decision. I left the room, called the surgeon, and amazingly, he picked up the phone, which might occur 10% of the time I call.
He did me a favor and got the patient in the next day. He agreed with the first surgeon, but he mentioned that MPT had had some success with these cases. He spoke to them about our traction treatment protocol (daily for 2 weeks). He suggested this because he wanted them to know they had tried every conservative non-invasive form of care before having the surgery, which he believed was inevitable.
Since I, also, thought the surgery was inevitable, I told the patient that I would be seeing him daily, including Saturdays and Sundays, for 2 weeks, but would not be charging him. The reason was, that in his case, unlike most back patients I see, I wasn’t confident that my treatment alone would be able to get him better.
The treatment began, the strength in his foot began coming back, and his leg pain was diminishing. That said, when I sent him back for his follow up, I thought that, since he did not have full strength in his foot, he would be heading to surgery.
Much to my surprise, the surgeon was impressed with his progress and sent him back to us to continue. Here is where the insurance company comes into play. At that time, I began writing up this case and billing the patient and the insurance company for only the next 8 visits we ended up treating him for. Our treatment total was 22 straight days in a row. He avoided back surgery and had a complete recovery. He has not had any re-occurrence in 2 years.
I have to admit, after writing my notes to the insurance company about this case, I was shocked when they denied the 8 visits billed by MPT. I was angry. I never had challenged the insurance before. I had been told that we couldn’t win and that it would only be a waste of my time. In this case, for the first time in my 35 years, I was willing to challenge the big insurance company.
The process the insurance companies use, in my mind, is unethical. I had my office manager call to challenge their refusal to cover the 8 visits we billed for. We were informed that a physician would call and hear our case. I was naively hopeful. My first contested case to an insurance company, seemed very justified and impossible to lose. The 8 visits charged had saved the insurance company from having to pay for a back surgery and all the recovery costs and possible complications that could have come about from that!
Unfortunately, I never realized that insurance companies pay doctors, who will not tell you their specialty or expertise, to refuse to re-reimburse your claims. There is, as far as MPT and many medical providers know, no good excuse for the insurance companies’ disregard for patient care.
I later found out that the physician is paid by the insurance companies to save them money. These so-called doctors get a percentage of the amount of money they save for the company. As a result, after hearing the story I just shared with all of you, he refused the claim and said he did not see any reason to change the original decision of the insurance carrier. Result: 22 treatments of one of their clients who was saved from surgery, and the insurance company didn’t have to pay a dime!
This happens every day to medical providers across the country, not just MPT. If anyone reading this can help, please call at 574-233-5754 or email me at Fran@McDonaldpt.com. There is one doctor, in particular, that I have spoken with a number of times, and he refuses to listen! He is denying case after case without any recourse and is getting paid to disregard and/or devalue the needs of the patients.
Thank you for listening to my frustration with this system! I hope someone out there can help us put an end to this system or at least improve it in some way. The medical community is losing too many caring doctors and other medical providers who are sick of not being reimbursed for their care.
Thank you,
Fran
