United's Getting Rid of Expensive Patients
This Letter to the Editor responds to the article Dropping Doctors: About Quality or Profits?
To the Editor:
Here is my take on why United dropped those doctors.
1. Some of the best doctors take care of the sickest patients, and then submit lots of bills for tests and treatments. Those sick patients cost the insurance company more than the premiums they pay.
2. The insurance company (such as United), sees that these specific doctors are associated with lots of bills they have to pay.
3. By dropping these doctors, two things happen. First, patients panic. More specifically, the patients that are expensive panic and switch insurance plans, so they can continue to see their same doctor. The first insurance company (United) doesn't have to pay for the care. It is one way to legally "cherry-pick" the healthy patients that provide more money in premiums than the insurance company has to pay out in benefits.
4. The other thing that happens is that doctors panic. "What if 50% of my business was from insurance company XYZ? If they dropped me, I'd really be in trouble!" So, it makes doctors more likely to agree to lower payment terms (getting paid less than what straight Medicare will pay), or risk losing half their practice if they got dropped by XYZ insurance plan.
5. Anyhow, the main goal of an insurance company is not to "manage patients cost-effectively." It is to cherry-pick patients to insure only healthy people. That is one of the reasons that single-payer health systems cost less than what the USA has.
Kenneth N. Woliner, MD