The article about Vancouver Clinic’s decision to end their relationship with Wellpoint was published the same day that I got a letter from Legacy announcing their decision to terminate their relationship with United Healthcare. While the press speculates that is due to contract payment levels, there is a darker side to this story: The difficulty in getting payment from these payers.
After working over 50 years in health care business management, I know how often insurance payers ignore the contract, creating a maze of loopholes providers must navigate. They add multiple layers of prior authorization and demands for patients to complete extra documentation, often resulting in denials of payment. To get a payment for services already rendered, providers must add staff to fight these battles, often with additional denials of payment. All this results in excessive administrative costs which is why the United States has the highest administrative costs in the world, yet our health outcomes rank us at around 36th in the world, the worst record for a developed country.
So, check with your provider before considering a payer selection: how hard is it to get their payment (you eventually pay the price for the excessive insurance profits).
