Precertification, denials and appeals


Fam Pract Manag. 2006 Sep;13(8):16-24.

Thank you for Dr. Anthony Akosa’s article “Precertification, Denials and Appeals: Reducing the Hassles” [June 2006]. It described how to manage insurance company red tape. The real issue, however, is why do we deal with any of it? Ending insurance contracts and dealing only with patient reimbursement is the only way to permanently end the hassles.

Insurance companies created managed care to increase their profit margins. They have succeeded. They deny care to patients who need it and create more work and overhead for physicians. It is unbelievable that physicians and patients have allowed this to happen.

Pay for performance (see the special section in the July/August 2006 issue of FPM) is another manufactured absurdity that no other profession or workplace would tolerate. This emperor has no clothes either!

As physicians, we are supposed to work for patients only, not insurance conglomerates who work for CEOs and stockholders.


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