I recently made a fairly vulnerable post on my tik tok here:
There's genuinely not a lot of reasons I will cry in front of people I know, nevermind an audience of strangers. But for the entire summer, I've dealt with a pit in my stomach over this.
Let me explain how health insurance companies work because a lot of people don't know from the back end.
We see you for a certain amount of time. We send a bill to your health insurance company. Ten to fourteen days later (if you're lucky), they'll send you either a check, or a letter denying payment.
We have a contracted amount of money we should receive in the check based on the visit.
That's fine and dandy, until the insurance companies don't pay it. Or they send you a check that's lower than you're supposed to be paid. But if you don't notice it, that's your fault. You should have noticed it and you need to notice it within the first 180 days. This is an immense amount of work for a small practice without a biller, and if you have a billing company, you are at their mercy hoping they are checking every single claim coming back for inaccuracies.
If you don't notice it within those 180 days and you do an audit 181 days later, that's really too bad and it's your fault. You worked for less (or maybe for free), and now they get to pocket that extra money. That extra money they mistakenly didn't pay you, despite your contract. The federal and state governments both support this in the legislature.
Anyway. In our case, this was an issue. We submitted a correct application for the insurance panel to take one of our providers. They made an error while processing it, and wrote in the contract that she should receive 10% less than every other person with this specialty. We didn't notice. I noticed the business was sinking and I wasn't making any money. But I didn't understand that it was because I was taking 10% out of the business money to compensate for the amount I thought I was supposed to pay this provider.
But don't worry, they protect themselves, because there's a clause in the contract that you are not allowed to discuss your contracted rate with your biller, your business associates - no one. So you sign that contract blindly as a new contractor with a practice, and then we all get to wait and see if the payments are equal.
We contacted them about it. We contacted the Department of Insurance about it.
You know what the Department of Insurance has jurisdiction to do? Nothing. They just make sure the insurance company "has a grievance process" which they can certainly skew in any way that favors them.
We were gaslighted and blamed. We were blamed for not noticing. It doesn't matter that we are a small practice offering good care to the community. It doesn't matter that it was their mistake. It just doesn't matter. Because they get to keep that money. They get to go log off and go to their families with their fat ass salary and live a comfortable fucking life with their Tesla parked in the driveway.
And you know what I get to do? I get to cry in my office, wipe my tears off, and go try to put a smile on my face in front of my two little kids. I get to think about how I need to hold it together for my daughter's third birthday on Monday.
I get to look at my $50,000 loan I took out to support the practice because of the deficits, and wonder how the fuck I can repay that. I get to look at my empty bank account and know that I won't be able to pay off the three credit cards I had to max out to support my family. I get to know that the work I did was a loss. And the people there get to keep the money we rightfully earned.
In my desperation trying to find a way to recoup this money, I've explored federal and state laws, along with any case in history that a provider went up against an insurance company for underpayment.
Did you know providers never win? Even if they do, the insurance appeals it, and wins.
And their money is endless. Ours is not. The injustice and power dynamic is so incredibly unfair.
Fun fact, did you know.. years after we complete a service and are paid, health insurance companies are allowed to come in and "recoup" the money if they feel they overpaid us. If they do that unjustly, you have no way to get it back. They just take it. And it's gone.
And you know, everyone shits on healthcare providers like we're all rolling in money. It's not us. It's not the providers who accept lower payments by insurance companies to make sure you can get affordable care. We are the exploited, not the problem.
It's the insurance companies. It's the people who have no knowledge about how to care for people.
And you know what? The people in those insurance companies who made those decisions to not pay us have no idea the work that we do. They have never had to sit in a room and talk someone out of killing themselves. They have never had to sit in a room with a child deformed from abuse. They have never had to hear the most horrific stories of sexual abuse, rape, domestic violence, and torture. They don't know any of it. But they have all the power. And our government only protects them. This needs to change.
This is why people do not take health insurance in the mental health field. We have no protection. We are at their mercy to decide if our work is worthy enough to deserve payment. You think we need more mental health services to prevent crises and tragedies like school shootings from happening? I promise you every school shooter has an intense history of trauma and they didn't receive the mental health care they needed.
Mothers who kill their babies in postpartum psychosis? That's an epidemic that access to mental health care could prevent. Suicide? It's suicide prevention month. That's an epidemic that access to mental health care could prevent.
I'm not sure how we can change the laws to put protections in place for small healthcare companies, but I am determined. The power dynamic is so grossly unfair. I don't understand how we allow healthcare providers who are at risk of being exploited to have no legal protection, but the health insurance companies have all of the legal protection.
This isn't just about me. This happens to so many others. It should not be legal. It should not be allowed.
I am continuing to take insurance for our business to keep supporting our patients and making care affordable but this is the price I am paying for it.
I'm so disgusted and sad. They expect me to sit helplessly as they pocket the money my business earned. I will not be quiet.
My response to them is if you are going to unjustly fuck someone over, you can do it publicly, not privately.
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