Let’s face it, for health insurance companies, profit is the bottom line. And we’re not just talking about a few hundred dollars here. From 2009-2012 the profits of Health Care Service Corp, which is the parent company of Blue Cross Blue Shield of Illinois, Texas, Oklahoma, New Mexico, and Montana, were over $1 Billion annually. Then in 2013, the Affordable Care Act (ACA) happened. Profits declined and the CEO received a bonus of $11.2 Million in 2013, down 30% from a bonus of $16 Million in 2012. Heaven forbid that should happen!! (Click here for a Crain’s Chicago Business article related to this.)
So what do they do? Well, for those of us in Illinois who have individual policies (and that’s over 300,000 people), we’ve already received our notice letter that all BCBSIL PPO plans will no longer be offered as of 2016. We will be given the choice of an HMO, the Blue Choice network, or a new mystery PPO that as of two weeks before open enrollment no one knows anything about. No big deal, right? Wrong! In Chicago, we have access to some of the best medical institutions in the world yet all major hospitals, and most independent providers, have chosen to not be a part of the HMO or Blue Choice network. (Click here for a Crain’s Chicago Business article on this development.)
And why would that be? The abysmal reimbursement rates would be why. Now that health insurance companies cannot exclude those with pre-existing conditions, thanks to the ACA (which I applaud), and they must treat mental health services equal to medical services, thanks to the Mental Health Parity Act (which I applaud), insurance companies must find a way to keep their bottom line and their Million dollar bonuses for their CEOs. So, welcome to the world of being a medical provider (which includes therapists such as psychotherapists, speech therapists, physical therapists, and occupational therapists) in our current health care system.
- For medical providers, health insurance reimbursement rates have consistently either been decreased over the previous years or were abysmal to begin with, which means your provider has to see more patients, work longer hours, and spend less time with each patient.
- Medical providers have no say in the reimbursement rate. In fact, did you know that BCBSIL, and other insurance providers, will not even inform providers of the reimbursement rate for services until the provider goes through the entire process to become a network provider. Then the provider is given the fee schedule and can choose whether or not to accept a network contract. And if you do accept a network contract, part of the contract includes that you will not publicly discuss or disclose reimbursement rates.
- Although there is the stereotype of the high-salaried physician, this is most often not the case, especially for primary care doctors and specialty providers such as psychotherapists. Did you know that doctors make 3 cents per hour less than teachers over the course of their career (Click here for a graphic of the math.) So providers choosing not to accept certain HMO and other health insurance plans is not about providers being greedy and trying to figure out how to finance that flashy car.
- And yet, your medical provider is the one treating your cancer. Your therapist is the one helping you overcome your depression. That emergency department physician is the one treating all the gunshot victims that you saw on the news this weekend. According to the American Foundation for Suicide Prevention, 300-400 physicians die by suicide each year. Male physicians have a suicide rate 70% greater than males in other professions and females have a 400% higher suicide rate than females in other professions.
The majority of medical providers care about helping others. It’s why we chose this profession. I know I did not choose to be a psychotherapist with the expectation that I would be a millionaire yet I also did not choose to be a psychotherapist to contribute to a CEO of a health insurance company making millions. Alas, this is our broken health care system. Providers cannot help you if they are unable to make a viable salary, so as the health insurance companies continue to decrease reimbursement rates to preserve their bottom line, more and more providers are opting out of the system. Access to care becomes a mute point when there are no providers in the system.
The BCBS change must be approved federally yet it’s time to start speaking out about provider reimbursement practices of all health insurance companies. Contact your local representative. Click here to sign a petition to stop this BCBSIL change.