What Arizona Docs are Saying - Impact of Insurance on Medical Practices
Print - Winter 2022
Why or Why Not?
No, they transfer you multiple times to get to a person who can assist. They cannot find previous messages from prior calls on the member. They do not care to work with you as the provider when things are not in your control, like COB issues. —Beth Hoff, DO
Yes, except for when they deny prior authorizations or give us conflicting information. It’s a huge burden and I need extra employees due to the many phone calls. —Sarah Patel, MD
No, insurance companies simply interfere with good healthcare to save themselves money; all in the guise of “quality.” They are less concerned with quality unless it can show in a metric in a way that saves them money. Saving money is fine if it is not on the backs of my
patients or myself. —Steven Reeder, MD
No, VERY inefficient in communication/authorization. Improper denial of payment and care services to patients. —Robert Cravens, Jr., MD
No, it is extremely hard to even talk to someone or get help when needed. —Sheena Banerjee, MD
No, in my experience the insurance companies don’t reimburse physicians right away or enough for our work. —Rebecca Abraham, MD
No, time consuming and frustrating. —Klee Bethel, MD
Insurance carriers add complexity to medical care, much of which may be unnecessary and done solely to put up barriers to care. —Deva Boone, MD, MBA
No, their efforts to cut costs tend to lead to conflicts about what is best for the patient. —Arthur Chou, MD
No, reimbursements for physicians are slim to none for the services and care provided to patients. —Linda Sodoma, DO
No, long holds. Multiple hoops to get meds. Always long roadblocks that I don’t have time for, and I become more aggravated. People at insurance company can’t even say meds let along know what they are approved for. —Randy Gelow, MD
No, too much red tape, time spent on authorizations and denials. —Bertrand Kaper, MD
Meet the participating Physicians:
Anne Maiden-Hope, DO
Cheri Nasson, MD
David M. Baratz, MD
David R. Sanderson, MD (R)
What role do you think insurance plays in today’s healthcare system?
Insurance role is to protect their clients from high medical bills but with soaring medical costs and the non-insured, the normal family pays extremely high premiums and then has high deductibles as well. —Sheena Banerjee, MD
They dictate all care and rates of care. —Rebecca Abraham, MD
Insurance seems to dictate what the type and extent of care is provided. —Paul Coulombe, MD
They are dictating how we practice medicine and limit the care we can provide. —Earl Labovitz, MD
Integral part but perhaps we would all be healthier without it. —Klee Bethel, MD
Insurance largely determines where and how patients can receive health care. Insurance companies, with their low and declining reimbursements, are contributing to the depletion of private practice physicians. —Deva Boone, MD, MBA
Private insurance is the ruination of healthcare in America. —Glenn Brown, MD
I think insurance plays a heavily negative role in today’s healthcare system for both patients and providers. Patients’ coverage is horrible, and they must pay out of pocket for most anything. Most insurances now are only beneficial for a catastrophic event. Providers are almost losing money with most insurance companies as reimbursements are so slim. —Linda Sodoma, DO
Headaches. RECORD profits with multiple roadblocks. —Randy Gelow, MD
They have successfully intertwined themselves into the fabric of the healthcare system. Unfortunately, their motivations are profit driven not patient driven. Until this changes, we are doomed to continue this pathetic relationship. —Bertrand Kaper, MD
Insurance has far too much power in the health and wellbeing of our populations. The admins (CEO, CFO, CIO, managers, administrators) of insurances effectively lump into one pile thereby dehumanizing the professionals (physicians, PAs, NPs, CRNAs, PT, OT, PharmD, etc...) by labeling them “providers.” The term confuses patients and healthcare workers alike who don’t know who is treating them and who is on the team. —Tammy Penhollow, DO
If that role should change, then how so?
They need to work better with the providers. They need to be held accountable for things that are said and printed. They need to pay for work provided and not get out of it every chance they get. —Beth Hoff, DO
They should not control the delivery of healthcare, or my patients hard earned healthcare dollars. They are just not very good at it. —Steven Reeder, MD
Channels need to be created for employers to contract directly with provider groups for services. —Robert Cravens, Jr., MD
Clients who are not sick a lot should be rewarded with lower payments and better plans, while people who do not take care of their health should be more accountable. —Sheena Banerjee, MD
It should be affordable to patients and doctors should get paid for their level of education and value. —Rebecca Abraham, MD
I would prefer a common formulary and open access of physicians. —Paul Coulombe, MD
One payer system for everyone. —Glenn Brown, MD
As a nation, we should have one level of basic health insurance for everyone and there could be other private health insurance plans layered on top of that. —Arthur Chou, MD
Let providers prescribe what they are comfortable with. In the end, what we do will likely cost less than 6 weeks of PT just to get an MRI which we need anyways - they just paid for 6 weeks of PT, and MRI, AND now surgery as well. —Randy Gelow, MD
Meet the participating Physicians:
Jane Lyons, MD
Joseph Brooks, MD
Practice: Arizona Specialized Gynecology
Phone: (602) 265-1112
Website: arizonaspecializedgynecology.com
Vinay Kwatra, DO
Mary Garcia-Kumirov, MD
Mark Baldree, MD (R)
Meet the participating Physicians:
Molly Solorzano, MD
Paul V. Baranko, MD
On a scale of 0 to 10, indicate how much of a burden
pre-authorization is on your practice.
Zero equals no burden and 10 equals a very high burden.
What are your suggestions to decrease the work for pre-authorization?
No prior auths should be required. We are physicians! We use our knowledge, not insurance criteria, when prescribing. —Sarah Patel, MD
Eliminate them! I have never found them useful! They are simply a barrier erected to impose frustration theory on physicians. (i.e., the more barriers put in the way; the more physicians will give up trying). —Steven Reeder, MD
Automate the process. The phone is the choke point. Insurers know this and use it to their advantage. Docs can’t afford to pay people to wait on hold. —Robert Cravens, Jr., MD
Physicians should not have to deal with this. Meds and tests should be overall affordable. —Rebecca Abraham, MD
Over 90% are authorized so other than to harass physicians and delay care I don’t know why it exists. —Klee Bethel, MD
Many of the pre-authorization requirements seem designed only to provide barriers to patient care, not to ensure quality care. Put up enough barriers, and it isn’t even worth it to get pre-authorization. The insurance company saves money just by putting up that
(unnecessary) barrier, knowing that it won’t be worth it for me to fight for it. —Deva Boone, MD, MBA
Create one website, similar to CoverMyMeds, that would handle all pre-auths and prior-auths; and/or health insurance companies to increase the number of staff to handle this process and who are trained to manage the vast majority of pre-auths and prior-auths so that all you need to do is make 1 phone call, speak to 1 person, and address the pre-/prior-auth with 1 call. And/or, as AI and interoperability improves, this process could become more automated given most clinics use an EHR. —Arthur Chou, MD
More automated systems i.e., by phone, or online to obtain pre-authorization for surgeries/ in-office procedures rather than waiting on hold for up to 2 hours on hold with an insurance company. —Linda Sodoma, DO
Accept our documentation rather than question it. —Bertrand Kaper, MD
Go to a direct primary care (DPC) or 100% cash pay practice. Stop negotiating with insurance. —Tammy Penhollow, DO
What steps should be taken to improve the relationship between insurance carriers and medical practices?
There needs to be an easier way for everyone to take care of the member without all the paperwork hassle and time spent on the phone
changing things every visit. —Beth Hoff, DO
Outlaw insurance companies from denying any service prescribed by a physician. Put the power back into the hands which it was
entrusted to in the first place. Trust the Hippocratic Oath to be fulfilled. —Steven Reeder, MD
Give us a phone number that we can talk to a real person about the issue we are having. —Sheena Banarjee, MD
Ability to communicate directly with the claims dept to resolve unpaid claims or to the review dept to get paid. —Earl Labovitz, MD
The insurance carriers do not care about their relationships with small private practices like mine. —Deva Boone, MD, MBA
Make them accountable to follow AMA and CMS coding rules. —Glenn Brown, MD
Invite more input from physicians from the community; not just as a one-off meeting or “town hall,” but an on-going relationship to
help implement new plans and then provide repeated feedback so that protocols and policies can be continuously improved upon. —Arthur Chou, MD
Streamline insurance companies and don’t allow carveouts - physicians nowadays can’t even begin to understand what plans cover
what services because there are so many exclusions and carveout plans. —Randy Gelow, MD
Pay physicians what they are worth. No other professional has been subject to decades of undermining the value of services offered other than medicine. Ridiculous. —Bertrand Kaper, MD
BE HEARD. CONTACT US ABOUT BEING IN THE NEXT WHAT ARIZONA DOCS ARE SAYING.
Interested in having your voice heard by your fellow peer physicians in Arizona? Contact us at information@arizonaphysician.com