Posted on 10/12/2025 6:18:42 PM PDT by CFW
ATLANTA — An initiative by insurance companies to reduce high-cost doctor visits could cause physicians to abandon private practice and work for big hospital chains, independent practitioners are warning.
They say the trend could drive up patient costs.
Cigna implemented a policy last week to flag bills that appear to be too high. The insurance company may reduce payouts by one billing level “when the encounter criteria on the claim does not support the higher-level” payment code, the new policy says.
Dr. David Eagle, vice president of the American Independent Medical Practice Association (AIMPA), expects the new cost containment approach to erode income for private doctors, with long-term consequences for their patients.
Providers will be able to appeal downgraded billing claims by sending detailed medical records, but it is a labor-intensive process, said Eagle, a blood and cancer specialist in New York. He suspects such “downcoding” decisions will be made using algorithms that rapidly assess claim forms containing few details. Small doctors’ offices won’t be able to keep pace, he said. “Basically, they’re going to be underpaying the doctors based on information on the claim form.”
Cigna said only about 1% of providers in its network will be affected by the new policy, which “aims to reduce overbilling.” A one-level claim downcode will result in an average $50 reduction in payment, the company said in a written statement.
But $50 per visit adds up for a practice that runs on thin margins, said Dr. Bradley Sumrall, a blood and cancer specialist in Macon.
(Excerpt) Read more at capitol-beat.org ...
I think that is the goal. Health care will be easier to manage and regulate into "one size fits all" programs if all doctors work for a large hospital conglomerate. Insurance companies now have total control over our health care decisions.
After ACA was passed many of our local doctors were bought out by the local hospital. Now, instead of Smith Orthopedics, it is "Hospital Orthopedics". There are a few remaining independent physicians, but this new regulation will probably be the final blow to those hold-outs.
To the insurance company and government regulators this would be a feature not a bug. Patients are way down on the list of health care priorities.
Direct Primary Care physicians cut out the insurance companies and provide care for a monthly fee. They also provide medical test for much lower fees because the medical bureaucracy tacks on so much.
And you still need hospital insurance
Bkmrk
You get what you pay for. Especially with medical care. The corporate/bureaucratic medical establishment only cares about their protocol$ and not what benefits you the most.
There are so many reasons unconstitutional gov’t healthcare should be abolished.
Here is a sampling of reasons:
1) Gov’t takeover of healthcare is unconstitutional and, thus, illegal. Nowhere does the Constitution delegate power to the feds to meddle in healthcare.
2) See 1)
3) Gov’t healthcare puts your individual healthcare in the hands of distant, indifferent, and non-medial D.C. bureaucrats and politicians who of course as middlemen must be paid and, thus, increasing the cost of healthcare. The HHS bureaucracy has a budget of $1 trillion.
4) The highest quality, most affordable, and most available healthcare in the world is what we had in the voluntary cooperation DIRECTLY between doctor and patient before the gov’t muscled in in the 50’s and 60’s with its “helping hand” hand out and a hammer behind his back! As Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the Government, and I’m here to help’”.
5) Gov’t hammer? What hammer? Forced vaccines, forced abortions, forced treatment all by distant politicians and bureaucrats who are not medical experts and do not know you personally.
6) Gov’t agenda vs. your own personal agenda. Who cares more about your health? You? Or some distant politician and bureaucrat who doesn’t know you from Adam and frankly couldn’t care less about you personally?
7) No one cares more about your health than you. Why in the world would you take your personal healthcare and your personal choices in the self interest of your health and wellbeing out of the hands of the DIRECT relationship between you and the doctor of your choosing who knows and cares about you, and instead put your healthcare in the hands gov’t politicians and bureaucrats who don’t know you, have the power to force you to do what they want, and who have their own agenda which includes “culling” the “overpopulation” - so gov’t has a bias toward your death.
8) That is a short list. There’s more but why would anyone need more reasons? NUKE UNCONSTITUTIONAL GOV’T HEALTHCARE!!!
McCain betraying the voters by voting “no” on overturning the ACA just to get back at Trump was one of the worst things done by a GOP Senator in recent political history. He had campaigned on overturning Obamacare and voters took him at his word. That was a big mistake. TDS has broken so many minds.
Roberts also made a mistake. I agree that the ACA is unconstitutional. SCOTUS should have tossed out the entire thing.
The HMOs came into my dad’s office years back and told him he wasn’t charging enough for his services. He kicked them out.
The HMOs began driving doctors out of private practice years ago and they make way too much money. They itemize everything out to each piece of equipment used and charge for things that used to be free. They have turned into huge conglomerates where everyone involved has to have their cut of the money.
The same thing has happened in veterinary care over the last 10 years. I talked to a retired veterinarian in town and he told me all about it. People can’t even afford to have animals anymore.
One of the goals of those who want total government control is elimination of independent medical practitioners.
It has almost completely succeeded. Finding an independent medical doctor is nearly impossible today.
They used to be common, 50 years ago. The push to corporate practice is huge, mainly to manage the increasing governmental burdens and liability coverage.
Independent doctors were community leaders and independent thinkers. Not something desired by the left.
Small communities could pay off medical degree expenses by insisting on a commitment to serve in their under served community. They’re usually foreign.
0bammy already caused this to happen with most of the good docs, years ago.
Sad that they’re giving the final blow to what few remaining indie docs are out there.
Paging MAHA .... please pick up the red phone....STAT.
This is not new - has been accelerating ever since the ACA was passed - doctor’s do not have resources - not just financial but also time - to deal with the cumbersome regulations and thus have to become a part of a corporation in order to survive financially...and keep their sanity.
The ACA / Obamacare was a corporatist bill.
After ACA was passed, and my primary physician joined a hospital system billing for an office visit has nearly doubled. I receive a physician bill for the doctor’s time, an “office visit” bill for the practice, and an outpatient hospital facility fee from the hospital system. In addition the time the physician spends with me has dropped from about 20 minutes to 10 minutes max. Lab fees for drawing blood, and xrays if needed, are another incremental charge.
We are paying for layers of executives in the hospital system, plus armies of clerks processing paper at the clinic level, the hospital system headquarters, and the insurance companies who never see a patient and who do nothing to enhance the health care of the patient.
Drug coverage should be separated out. That way hospital systems can be complete providers of care and could cut insurance companies out of the care paying picture.
Hospitals should generally be broken into two so they no longer are local monopolies.
If a hospital is too small to be broken into two, it should be converted into a real estate entity renting out space to licensed individuals and partnerships of licensed persons.
This first happened to pharmacists, then to doctors and is even crowding out private veterinary practices.
Cinema’s disgusting. They push local pharmacies off their preferred list to drive them out of business, because they own CVS, another execrable company. Wouldn’t doubt if they also owned hospitals and clinics. Their part D premiums are triple for the coming year.
This is nothing new.
Battling over CPT codes has been going on for years and years.
Dr. David Eagle, vice president of the American Independent Medical Practice Association (AIMPA), expects the new cost containment approach to erode income for private doctors, with long-term consequences for their patients.
Translation: Services and procedures falsely coded at higher reimbursement levels will be flagged and reviewed. They should be treated as insurance fraud.
Insurance companies have set prices for each billing code. Providers agree to these fees or they can not bill for reimbursement.
Not uncommon to pad a bill and cross your fingers. It’s just a ‘billing error’ that is easily corrected by refunding the overpayment. Sounds like some of these docs are admitting to ‘billing errors’.
There are other coding systems besides CPT.
I believe the French have a system and the Germans also have a system.
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