Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Thursday, July 31, 2014


If you read my post, Why would I do that?, you'll learn that I've been puzzled about an insurance phenomenon. I get these faxes from insurance companies, asking me to agree to an expedited fee for my services. For example, if the patient has submitted my bill for $300, the insurance company will suggest I accept $186. In addition, my signature on the form indicates that not only will I accept that amount, but I agree not to bill the patient for the difference.

I also get phone calls from the company asking me to call back and "negotiate" a fee, meaning I'll agree to accept less than my actual fee.

I could never understand how this constitutes a negotiation, since the insurance company is saying, "If you accept this amount, in exchange, we'll give you absolutely nothing. Would you like to be paid $300, or $186 for the same service?"

Hence the title, "Why would I do that?"

I think I've figured out why they think I would do that. In my disgust with these forms, I seem to have missed 2 key points.
1. The claim that this is a "time sensitive document." I assumed that was just an attempt to get me to sign it without thinking. And
2. the line, "Provider agrees to accept the above, provided that payment is released within 10 business days from date of receipt of faxed/digital signature."

It seems what they're offering in exchange for a lower fee is quick payment. I'm guessing this means that my lack of signature/agreement indicates my willingness to wait around indefinitely for my payment, if it's sent directly to me, or for my patient to wait around for his reimbursement.

So once again, the insurance company wins. Either they have to pay me quickly, but much less than my actual fee, or they can pay me whenever they feel like it, with all the snags and wrenches that can be encountered along the way, in order to delay payment.

It also tells me that the insurance company is more than capable of paying in a timely manner, but they consider themselves exempt from any such reasonable behavior. What do they do if a client is chronically several months late in paying her premiums?


  1. I follow a number of financial sites and this blogger had a good post about how her personal medical insurance has been affected over the years. I can attest to the fact that she is right on based on my conversations with ex-insurance company insiders over the years and observing their overall strategies:


    Losing claims is an excellent "incentive" for both doctors to "settle" and compulsive patients to pay out of pocket rather than risk a hit to their all important credit rating.

    1. Great link! For those who didn't read it, if you contact Cigna multiple times for a problem with reimbursement, they'll ask how many times. And if it's >3, there's a 50% chance you'll be disconnected in the process of transferring you to the "appropriate" extension.
      I once called my insurance company with a question about a denied charge from my gynecologist, and I got transferred to a car dealership in another state. For real.

    2. That's ridiculous. I have Cigna combined w/ Tufts (a MA insurer). Cigna can be a pain in the ass, and their behavioral health network sucks. Tufts is okay, but we only get them for medical care. We've been fine with Cigna, but only because they administer a self-insured employer plan. If we have a certain number of problems, we go to a woman in HR who handles it. I would never buy insurance from them directly. I don't think they operate in our small group or individual markets.

  2. I get these time sensitive requests to accept a discounted fee for patients who have already paid their fee in full -- it's the patient who is waiting for their reimbursement, but the insurance companies want to 'negotiate' with me. I still don't get it.

  3. Glad you posted about this. I just got my first one. Aetna called me asking for my biller's info. I asked them what it was about and they wouldn't tell me! Weird. Then they sent the fax to my biller. Pt has Aetna as primary and her husband has a much better plan (Premera). I take Premera so will wait to get the better reimbursement but it is such a pain. And I do love the headline of "Why Would I Do That?". Well, I wouldn't!

    Another insurance company sent me "quick" payment in the form a credit card payment -- of course I have to pay 3% fee to use it. Then they offered to direct deposit for 1%. I told them I didn't want to pay to be paid and they could just send me my check in the mail as they have been doing. Then, miracle of miracles, then waived the direct deposit fee -- it is much less expensive for them. The joy of private practice!