Only Insurance Companies Win
Given recent events, I feel compelled to say I do not condone violence.
As an optometrist, I believe that insurance companies (which are for-profit businesses) are driving up the cost of healthcare at the expense of providers and patients. I spoke with a chiropractor and a medical doctor who also agree with this sentiment. This issue appears to be pervasive throughout the healthcare industry.
Below I am going to use optometry as an example because it's the industry I know.
We will start with discussing the cost of lenses. I own an edger which cuts lenses for me, meaning I can make a pair of single vision polycarbonate lenses for a mere fraction of what I have to charge if we are billing insurances.
However, insurance companies simultaneously refuse to pay optometrists our retail price while also forcing us to use their labs (instead of using my edger), and the labs charge me 11x for lenses comparable to the ones I can make in the office. Then, with insurance companies refusing to pay our retail price, I have to mark up that pair of lenses an additional 3x (for a total markup of about 33x) just to make a small profit. Providers are forced to come up with creative ways to try to pass on expenses to patients just to make ends meet. Which is unfair to the patients, and makes them feel like we are “upselling” them… and neither one of us likes any of it.
Patients understandably like to buy glasses which are covered by their insurance. But, I think what the insurance “covers” is not an accurate description of what’s happening. An example is when insurance says something like “30% off __.” Who is paying for that 30%? Not the patient. Not the insurance. It's the doctor taking a loss. Which is another reason why we have to jack up prices to be able to afford to give these discounts to our insurance patients, and it further prices out cash-pay patients.
It is illegal for optometrists to set different pricing for patients who have insurance, vs those who don't. Meaning, patients without insurance are forced to get creative as well (to be able to afford to see), and buy glasses online - where about 80% of the time the glasses are made with the wrong prescription. Now the patient is suffering with the wrong prescription, the doctor loses a sale, and we actually need the sale to cover our expenses. Who do you think this law was invented to protect? Because the only ones who are benefitting are the insurance companies.
The work-around is optometrists who have been able to find the money to buy a low end edger, like mine, for the cool price of $35,000, can offer discounts to patients who pay out of pocket. But, heads start turning when a business promotes an aggressive discount year round, and patients also start wondering what is wrong with the quality of the product. But that's how much discount optometrists who can afford to own an edger can give because of how much the labs mark up the lenses. And of course, to the consumer it looks like we are being greedy with our pricing if we are capable of sustaining such a severe discount. When in reality I can offer significantly lower prices for the same products to patients who are paying out of pocket because we are cutting out the insurance companies as a middleman.
Another indirect way that insurance companies hurt patients is the insurance companies are the ones who decide how much doctors are paid. When I bill insurance companies for a service, they are the ones who decide how much they will pay me. Insurance companies have not increased our reimbursements for about 20 years. Imagine making the same as you did 20 years ago in today's economy. Then imagine, as a business owner in private practice, needing to pay employees more than twice as much as 20 years ago due to the increasing cost of minimum wage. Do not get me wrong, the employees NEEDED a raise, but the doctors deserved to at least keep up with the cost of inflation.
The way this hurts patients is optometrists have to see twice as many patients in a day as they used to 20 years ago in order to be able to barely pay their employees as well as themselves. This means the patients are spending less time with the doctor and may experience long wait times if anything goes wrong with the schedule.
Optometrists do sign contracts with the insurance companies agreeing to their reimbursements. We can hire a lawyer to individually argue higher reimbursements for us (and hiring a lawyer is the ONLY way we stand a chance of winning). But, the cost of hiring a lawyer for every insurance to argue reimbursements is fruitless because the doctors almost never actually win.
I can see how I may sound like I am coming from a place of entitlement. But I want to make sure this is clear: by essentially controlling directly and indirectly the cost of every aspect of healthcare, insurance companies are degrading the patient experience. The insurance companies are also responsible for making healthcare unaffordable for patients who don't have insurance, which can be the difference between life, bankruptcy, and death.
Part of why it is so hard for Optometrists to win legislation that could help this situation is the perception in our society that doctors are rich. A bigger barrier is that insurance companies are so rich, doctor associations (such as the AOA - which is like our union) can't come up with the funds to compete.
Remember, much of what I have said here can be applied to multiple healthcare industries, not just optometry.
What the public CAN do about this is share this post, write to your legislatures, and file complaints with your insurance companies. We need to raise awareness and also create a movement to affect change.
What I can do about this is invite you to join the SSO Club.
