Doctors and Health Insurance

One of the things that I have learned in practice is that I didn’t learn something in my training. Only after starting work did I realize that patients think that doctors know things about health insurance. While we may know more than the average person since we have to deal with it more often, with the wide variety of health insurances offered, we generally don’t know and can’t know about all the ins and outs of every different insurer. The vast majority of doctors are never taught about this in medical school or residency. Many offices employ staff whose full time job is specifically to deal with insurance companies, and frequently, even they don’t know everything about all insurances because of the ever expanding universe of health insurance! For example, I recently learned that there is a health insurance company that bundles the cost of corneal transplant tissue with the surgery reimbursement code. What that ends up translating to is that, in certain situations for certain patients, the cost of the tissue is almost twice as much as the total payment from the insurance company for the surgeon doing the surgery, the rent of the operating room and staff, and the tissue! Obviously, this means that the surgeon and the surgery center have to take a loss to buy the tissue and do the surgery for free with this insurance. The insurance company has created a situation (that it may or may not be aware of) in which anyone on that insurance may not be able to get corneal transplant surgery with their surgeon (and will have to be referred to a different surgeon with a different kind of OR that might get paid better by the insurance company), which means, at the very least, a lot more hassle and wait time for the patient. These are things that doctors almost cannot know before they stumble upon a patient with this particular insurance, and, just to make things more fun for everyone, they change frequently. Doctor’s offices are constantly trying to stay aware of these changes, and it is good to get the word out to patients so they know about this ever-changing universe of what and how insurance companies cover.