It doesn’t make sense to me…

I can keep my cell phone number when I change service providers but I can’t keep my doctors when I change insurance companies.

As I was filling out yet another insurance application for what will be my 3rd health care provider in the past 12 months —  a situation predicated by changes my employer decided to make — the question popped into my head and a knot formed in my stomach, “Are my doctors on this provider’s approved list or will I be forced to choose? The choice: change doctors or see my doctors and pay a huge $1,000 (or higher) deductible. Some choice! Moreover, I don’t understand why, in this day and age, I’m continually faced with this dilemma.

A few years ago the FCC stepped in to protect consumers with “Wireless Local Number Portability (LNP) ” regulations. Wireless LNP allows consumers to switch from one wireless carrier to another within the same general metropolitan area. Government officials realized people had a lot of vested interest in their phone numbers.

Well, I have a significant vested interest in my chosen health care providers. I have an established relationship with my doctors, one that has developed over several years. My doctors know my health history, I understand their approach to care—we have a good working relationship. It’s a relationship that I value at least as much, if not more than my cell phone number.

Does this make sense to anyone?


  1. Anglico

    July 26, 2007 at 5:23 pm

    Not to me. In fact, you could make a pretty good case that this practice of “non-portability of care” adds both costs and risks to the delivery of services.

  2. sturner

    July 26, 2007 at 5:35 pm

    You will not be surprised to learn it is all about money. Each doctor (or group practice) negotiates an individual contract with each insurer. Doctors are forbidden to discuss with each other what they are being paid by the insurance company (for fear of “collusion”). You literally have no idea what other doctors are paid. Frankly, there is very little “negotiation.” The insurers dictate an offer, and you take it or leave it.

    From a practical standpoint, most doctors do not want the aggravation of having their existing patiens leave (or accepting disgruntled patients from another provider). Consequently, they will tend to accept any offer from an insurer that will allow them to remain financially viable. If a primary care doctor does not accept a major insurer it usually means the reimbursement offer was really, really, really, (insultingly) low.

    Finally, many contracts are pegged as a percentage of Medicare rates. As Medicare rates have continued to fall…you guessed it…all your doctors other contracts pay less, too. Medicare rates do not keep up with inflation, particularly the inflation associated with running a medical practice (which is higher than the standard inflation index).

    The deck is stacked in favor of the insurers. They continue to consolidate and merge. Physicians have gone to smaller size (specialty-specific) practices. MD’s really have no negotiating leverage. Insurance companies do not reward (and probably don’t recognize) “quality.”

    So, no, it doesn’t make any sense. Notice that nothing I mentioned above had anything to do with actually providing any medical care. But if your provider isn’t taking your insurance there is probably a very good reason for that…like the expense of treating you is greater than what the insurer will pay.

  3. aplum

    July 27, 2007 at 9:00 am

    Anglico, thanks for summing up the situation so succinctly. You hit the nail right on the head. We need to address the ‘non-portability’ problem as part of overall health care reform.

    Steve, insurance companies create an atmosphere of fear to protect their very profitable businesses. They’ve planted the notion in the individuals mind that ‘health care is unaffordable without insurance’. They reinforce this on every billing statement when they show the cost of the doctor visit at some exorbitant amount that is then negotiated down. I suspect they play the same game with doctors, telling them they won’t be able to collect payment from the patients, doctors will get stiffed without the insurance company acting as middleman. Is either scenario really true?

    Consumers and doctors need to get together and form a health co-op and cut the insurance middleman out. Easier said than done though.

    ‘m afraid that the insurance industry has been so effective at creating barriers to entry in its industry that substitute products simply don’t exist. Consumers and doctors view themselves as having no other choice than take what the insurance companies offer. Under these circumstances it is virtually impossible to restructure the health care system in the US.

  4. sturner

    July 27, 2007 at 9:46 am

    You are exactly right that it is easier said than done. My group has been part of a health consortium in Wake County trying, for three years, to do what you have outlined and eliminate the “midde-man.” We have approached most (all?) employers in this area with a minimum of 100-200 employees (especially RTP) about this model. Employers like the model, but are unable to take the leap of faith it would require. There are many legitimate obstacles, too (such as how to cover employees in different states or countries).

    A single payer plan with low administrative costs still makes the most sense.

  5. aplum

    July 27, 2007 at 10:29 am

    It’s good to know that groups are trying to find solutions. I wasn’t aware of the efforts of the health consortium in Wake County.

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