Insurers benefit when patients are insulated from the true cost of care

LETTER — Posted July 4, 2005

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Regarding "Out of network, out of luck: The perils of breaking the tie" (Article, May 16): Your article decried insurance reimbursements being withheld from providers, forcing physicians into the sordid and archaic practice of actually collecting their fees from their patients.

In the article, Raleigh, N.C., emergency physician Jim Palombaro, MD, comments "You don't need to have the patient in the middle of this."

I think that is exactly what is needed. Insolating the patient from the cost of his own health care through a third-party payment system is a major factor in the burgeoning of health care demand, avoidable expenditures, defensive practices against frivolous litigation, and inflated pricing of goods and services.

It has, however, been good for the medical insurance industry. When patients get "sticker shock" from their medical bills, they don't sympathize with their doctor or their hospital -- they thank God for their insurance.

In that same article, another source states that "many medical groups appear to be intimidated by insurers and view leaving major networks as a foray into dangerous territory." This may be an understatement. I suspect almost all physicians who "participate" (such a voluntarily, cooperative sounding word) in contract medicine do so out of fear -- the quite justifiable fear that if they do not, they will loose their patients, their practice and the livelihood that they spent their life preparing for. The consequences of nonparticipation are exceedingly intimidating.

Joseph N. Michelotti, MD, Elgin, Ill.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/07/04/edlt0704.htm.

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