[Jayla]

This is something I've been wondering about lately: How much do insurance providers (private or public) dictate what you can or cannot do for a patient? For example, if you felt a pt needed to be referred to a specialist, or for a special (and maybe expensive) procedure, are there penalties for the practice that refers?

I guess I'm ignorant to how this works since I'm not at all involved in billing or reimbursement where I work as an RN (not in NP school yet, either). I also for some reason see insurance companies as these big, evil entities--maybe I'm wrong. I'm just wondering how much insurance providers impact your every day practice and whether less than optimal care is provided because of them.

Thanks!

[zenman]

Originally Posted by Jayla

I also for some reason see insurance companies as these big, evil entities--maybe I'm wrong. I'm just wondering how much insurance providers impact your every day practice and whether less than optimal care is provided because of them.

Thanks!

I worked for an HMO for a year once and wished they would all turn belly up. I personally don't take any insurance for my shiatsu practice and probably won't when I'm an FNP. Insurance companies dictate too much of what you can do and what they will pay for...which is as little as they can get away with. With more research now being done on complementary methods, I can see an insurance company saying that they will only pay for say acupuncture needle placement at so and so point because research shows that it is effective. For this reason, and a few others, I may never return to the USA. I'd rather take chickens or vegatables for payment if someone had no money!

[Jayla]

Thank you for your reply zenman. It's a shame that CAMs are not taken more seriously in the US. I hear the NIH is planning to put quite a bit more money into researching these methods which may garner more support for those of us interested in providing it or simply having it available for our patients. Interested pts need to educated and monitored by a practitioner educated in CAM.

In my early 20s I worked in several health food stores that sold supplements (herbal and vitamin/mineral), and I saw how many people self-prescribe. It's pretty scary, considering these supplements can also have adverse effects if taken incorrectly. But that's a whole 'nother issue.

No one else has any opinions regarding this issue? I can't believe it!

I guess this is something not worth worrying about since it doesn't seem to elicit responses, either positive or negative...

[sirI]

[quote=Jayla]
No one else has any opinions regarding this issue? I can't believe it!

I guess this is something not worth worrying about since it doesn't seem to elicit responses, either positive or negative...[/quote]

I think you know there is interest about this subject as evidenced by the number of views of this particular thread (64).

But, the replies would be about the same; until our government (U.S.) decides to intervene on behalf of the patient, we healthcare providers are at the mercy of the third party (insurance company) if we utilize this for payment. If an exam/dx test is performed or referral is made without the insurance company giving permission, said exam/test and/or referral payment is denied. Unfortunate, but, a fact.

I continue to advocate for the patient, however, and hope to someday live to see this changed.