Health care reform: A moral issue to ponder

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By The Staff

I write my story about healthcare as a physical therapist, who retired after

32 years in large institutions and private office. Healthcare is a subject close to my heart. My story is long and I ask for your patience to hear my voice.

I am a graduate of the University of California Medical School. I started my practice first as a staff therapist in a large county hospital, followed by private hospitals and clinics, ending in private solo practice where I provided specialized physical therapy services primarily focusing on pain and stress management and education.

All was going well until one day an insurance company refused to reimburse me for services rendered unless I complied with its billing requirements, more specifically, “price per code” billing. I had no idea what that meant. What code and what price? Who assigned codes and prices to procedures and modalities, when I had been using to treat patients for years? I had been charging simply per hour of my time, which started as $60 per hour in the 1970s and ended as $80 per hour in the 1990s.

Having consulted with my colleagues, I discovered quickly that the “codes” and “prices” were obtainable from the Workmen’s Compensation Board, and that was the accepted standard for billing insurance companies. When I calculated my services as required, my fee of $80 per hour ended up being $120-$130 per hour for the same services rendered to a patient. I informed the insurance company in question and told them that it would cost them more if I followed their rules. The voice on the other end of the phone line assured me that it was fine, and that it was the only way I would be paid. I had no choice but to comply.

Before long, more insurances companies entered my town, each with its own rules, paperwork and contract demands. This time I was told that I could not see a patient without “prior authorization” from the insurance company if I wanted to be assured of reimbursement. I was told that I had to sign my name to such an agreement. Shocked by this demand, I told the insurance representative that I could not sign such a contract because I could not morally obey it. What it meant to me was that if a patient walked into my office late on a Friday, doubled in pain, I had to spend that last hour calling the insurance company to receive prior authorization before I could help that patient

I never signed that contract. Curiously, that same company would not reimburse me for my $80-an-hour honest work but instead would give me only half of that amount. When questioned further, I was told that I should see two patients in that same hour to get my $80.

When I explained that it was not possible because of the way I treated patients, that was meaningless to the insurance company representative. Clearly the representative had no idea of medical and therapy requirements in treating patients.

What also occurred as time progressed was the insurance companies’ significant delay in timely reimbursements for services rendered. I used to be reimbursed between 30-45 days after billing. That time became often extended to three or four months. My office expenses such as rent, utilities, telephone, supplies and yes, malpractice insurance had to be paid monthly. After two years of such headaches and stress at the end of which I was in the red for the second year in the row, I was forced to close my practice well before my retirement age. I grieve deeply to this day.

Today, it is a standard operating procedure, I am told, to “pad” insurance bills because insurance companies will pay only a fraction of a given bill.

This situation is deplorable. It serves no one. It makes health care providers like me quit, change professions or be forced to become bureaucrats. That is not what we were trained for!

What we have is a disaster leading to a greater disaster for our economy and our nation.

For those who oppose President Obama’s idea for government to provide an alternative affordable health insurance and who label it as an unfair competition in a free market economy, I have these few questions: Have you a better solution for providing affordable health insurance for those who simply can’t afford the current privately offered insurance plans? Do you trust business-for-profit insurance, affordable only for a few, or a system for protection of people’s health and prevention of disease as its primary goal that is affordable for most? Why not have both options available for people to choose?

If you ask: Do we need healthcare reform? Why so quickly? Why now? My answer is overwhelmingly yes!

It has been too long in waiting and now it’s time has come!

Janina Green retired after 32 years of experience as a healthcare professional in a variety of settings, from large instituions to private practice.