Texas Insurance Shoppers

Doctors and health insurance carriers in Texas are not too pleased with each other at the moment. Doctors are disgruntled about denied claims and lower reimbursements, and health insurers say that docs are over-treating patients and driving up the cost of health care. Doctors point out that health insurance carriers are making sweet profits, while doctors are seeing more rejected claims, spending more time trying to get paid, and making less money than they did ten years ago. But health insurance carriers are wary of ever-increasing prices on claims for high-tech treatments like MRIs, and are accusing doctors of price fixing. A group of 600 doctors in Tarrant County were recently accused by health insurers – and the Federal Trade Commission – of banding together to set minimum prices for treatments. The doctors said they were just trying to get fair reimbursements, but a judge has sided with the FTC and forbidden the doctors’ group from asking members what minimum prices they will accept.

This battle has been going on for ages, and it’s not likely to end any time soon. With rapidly rising health care costs, everyone is searching for a cause. Medical providers and health insurance carriers like to point fingers at each other, but the underlying causes of health care inflation are probably a combination of factors that involve both groups. We do overuse our health care system – alot more health care than most other countries. Doctors could probably provide fewer treatments without seeing a decline in patient health. But at the same time, health insurance carrier administration costs – everything that is not spent on medical claims – increased 118% between 1996 and 2006. Doctors feel shortchanged in the deal, as they are seeing more claims denied and lower reimbursements, while health insurance carriers are spending more money than ever on non-claims expenses.

The ultimate losers in the whole battle are Texas residents, who have to work with both doctors and insurers in order to have access to health care. A system with more transparency, better communication, and less red tape would benefit patients and lead to less bickering in the health care system and ultimately more focus on patient care, which is what the whole thing is supposed to be about in the first place.

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