In this episode of UpMed, Dr. Erica Rowe Urquhart explores the challenges faced by private practice doctors in local communities, highlighting the adversarial role of insurance companies. Through a reflection on increasing patient costs, the concept of the 'other,' and administrative hurdles such as downcoding, prior authorizations, and retrospective audits, Dr. Urquhart reveals how insurance companies avoid paying providers and add to the administrative burden. This episode delves into the complex dynamics of the patient-provider-insurer triangle, examining how insurance practices impact patient care and the sustainability of community healthcare providers.
EPISODE HIGHLIGHTS:
Identifying the Enemy in Healthcare: The Insurance Company
Insurance Companies' Strategies Against Providers
Challenges with Prior Authorization
Retrospective Audits and Payment Processing Issues
High Volume Scrutiny and Its Impact
The Adversarial Role of Insurance Companies
The Bleak Future of Community Doctors
Conclusion and Call to Action
