Archive for November 27th, 2011

Courageous Brownsville Doctor Rejects Humana – Will Others Follow?

Sunday, November 27th, 2011

          In today’s issue of the Brownsville Herald there appears an announcement by a local physician of his decision to no longer accept Humana Insurance patients.

The problem with this, as we see it, is the fundamental nature of the patient / physician relationship. Patients should be able to choose any physician of choice. Physicians should retain the same right in choosing and building their client base without third party interference.

A patient/physician relationship is based upon a contract. The physician agrees to provide a service and the patient agrees to pay for that service. A third party, such as an insurance policy should be irrelevant to the transaction. The insurance policy will pay what it will pay, nothing more and nothing less, irregardless of the patient/physician contract.

However, the traditional patient/physician relationship has changed with the advent of “Managed Care.” Patients and employers who sponsor group medical insurance have essentially given up their “contractural rights”  by allowing  third party intermediaries to represent them and be bound by them. Physicians, historically poor businessmen, have done the same.

Purchasing health insurance through carriers that require participation in their proprietary PPO networks such as Humana, Cigna, Blue Cross, United HealthCare and others effectively handcuffs the patient and physician to a very large degree.  The patient/physician contractual relationship is relegated to “second class citizenship” status by secretive PPO contracts that effectively rule the relationship and has “veto” power over both of the intended beneficiaries.

The good news is some employers who sponsor group health insurance and fed-up physicians are, after 25 years of failed Managed Care strategies (arranged and supported by third party intermediaries) are taking back control.

Self-funded employee welfare plans is the only vehicle available to employers who want to take back control of the patient / physician relationship. The fully-insured group medical market is not a viable option.