From: Ron Werter DPM
Just a thought right now. Sending the report by the government back to the insurance companies instead of the charts they ask for.
Ron Werter, DPM, NY, NY
From: Paul Kesselman, DPM
I was in practice for over 35 years and had the opportunity to share office space and staff with an internist. He and I became very close and I developed a very keen awareness of the pressures these generalists faced when referring patients to any specialist, not just DPMs. Thus, I saw first-hand the valid issues presented recently by Dr. Jacobs. I am sure he would agree, that does not give the insurance companies the right to pay for substandard care, nor does it alleviate the legal, ethical, and moral responsibilities of the referring physician to get their patients to the right specialist in a timely manner. And simultaneously it does not alleviate the responsibilities of the treating specialist to provide the proper care. Yes, there are theoretical and practical matters at stake here, as Dr. Jacobs duly noted, and walking that line is often a tightrope, but nevertheless everyone in this game, including the patient, must be involved in negotiating these hurdles.
This topic has gotten so heated that a recent U.S. Senate report on this matter was released yesterday and is available at: U.S. Senate Hearing Bashes Medicare Advantage Plans for Using P/A as a tool to boost profits. This report singled out the largest Medicare Part C plans, not just one, and cited 10 takeaways, which I urge everyone to read. What strikes me is that less than 10% of denied prior authorizations were appealed. The report does not reflect how many initial denials were overturned and the eventual health costs to the patients, who may have ultimately paid the price. Hopefully, this is a good start in dismantling a system which is in fact costing the taxpayers more money!
Paul Kesselman, DPM, Oceanside, NY
From: Chris Robertozzi, DPM
Medicare Advantage Plans’ deceit is the new game in insurance fraud. Back in 2007 or 2008 Aetna and Cigna were convicted of insurance fraud for not reimbursing their insurers for lab fees that were a covered service. The amount of money that should have been paid to insurers was over a billion dollars for each insurance company. Aetna and Cigna were fined $250,000 each and did not have to compensate the insurers for the money that was inappropriately withheld.
Of course, they were told to stop and desist that practice. When the CEO of Aetna was interviewed, his response was that it’s just a business decision. Two years later, they were back in court for the same thing. The outcome of that trial never...
Editor's note: Dr. Robertozzi's extended-length letter can be read here.
