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On Friday, the San Francisco Chronicle, reported that Aetna was suing six NJ physicians over medical bills that it called "unconscionable" including $56,980 for a bedside consultation, TSB hopes that at least the patient got a back rub and foot massage, and $59,490 for an ultrasound that usually costs $74. Yet, before the media and general public pass judgement on these fellers, some clarity must be placed on this alleged chicanery. The usually public demonization of doctors has already started, David Lansky, the president of the SF based Pacific Business Group on Health has already been quoted as saying, "if these charges are accurate, consumers and purchasers should be outraged!" Really Mr. Lansky?
Whether the public believes it or not, the fact remains that physicians have been able to flex their pricing muscles for years when it comes to out-of network benefits. And if what Arthur Lebowitz, Chief Medical Officer of Health Advocate Incorporated, an advisor to the insurance industry states is true, "that out-of-network physicians can charge what they want, and rightfully so, and that the challenge is coming up with an agreeable and acceptable customary rate is an accepted practice in the industry, what is the big deal?
But before the public castigate these physician culprits, let's take a look at Aetna's history in the Garden State. In 2007, the company attempted to impose caps on out-of-network payments resulting in a fine of $2.5 million (chicken scratch) because the consumer was being forced to pay balances other than co-pays. In 2009, Aetna, Wellpoint, Cigna and the United Health Group were accused of underpaying out of network physicians BY MANIPULATING THE DATABASE USED TO CALCULATE PAYMENTS, and paid a total of $90 million in fines to the Empire State without admitting any wrong doing (that's TSB's favorite part of all these settlements). Of course the insurance industry is crying wolf, because they rarely make any money providing insurance for their subscribers. The fact remains that AETNA's revenue for 2010 was $34 billion, a decrease of 2% over the prior year, yet, THEIR NET INCOME ROSE TO 38% to $1.77 billion. What other industry can accomplish this? Maybe if CEO's at these companies weren't so greedy, the lovefest between insurer and provider could come to a resolve? Does William McGuire earning $124.8 million dollars and backdating stock bring back any memories in the CalPERS law suit, whereas ol' Billy Boy had to pay back $30 million.
Public records indicate that Aetna's CEO Ron Williams took a 6% pay cut in 2009 and still earned more than $18 million dollars, making his package $5 million dollars more than Wellpoint's Angela Bray, whose compensation in 2009 was a 51% increase. In 2008, Williams earned $24,300,112 in total compensation with more than half coming in option awards. Isn't something fundamentally wrong with this picture? But then this poses a larger question, isn't the insurance industry making the rules for the game that physicians play in? Before the general public expresses its outrage, maybe its time to take the insurance industry to task. As premiums continue to soar, and people are denied coverage for pre-existing conditions maybe its time that the physicians and the public coalesce and fight the fight together. Until patients comprehend that they have the right to challenge any denial and threaten public scrutiny of these practices, things will continue as usual.
And what does this say about the POTUS? Didn't he cut a deal with the insurance industry mandating that Americans have insurance coverage utilizing tax dollars to subsidize their premiums? Isn't this socialized medicine with a different twist, and the only difference being that tax payer dollars are being funneled directly to the insurance industry? The fact remains that there aren't too many other industries where someone like Mr. Williams can earn a free-market salary while using the government to corral subscribers and the taxing power of the government to pay for your premiums? But you know what TSB says, when executives earn more in a day than most teachers do in a year, something is fundamentally wrong with the system? Considering that physicians are not provided a cost of living increase and are only allowed inflationary adjustments, maybe the time has come to challenge the insurance industry? But then this will be a challenge considering that most state insurance commissioners are former employees of the insurance industry themselves. So in closing TSB wants to know what our fellow surgeon bloggers think, is it time to stick it to the insurance industry or is this just a strategic plan to force litigation in order to arrive at an acceptable and agreed upon reimbursement for out of network services?