Overpaid?

A recent article in Healthcare Business Today did an excellent job summarizing the current state of affairs in the independent primary care medical practice. I encourage everyone to read it.

Over the past year there have been posts asking if doctors are overpaid or if we are the college tuition bank for the doctor’s children. These are valid questions and I provided a lengthy reply sharing my thoughts regarding the college tuition bank post.

I have thought a lot about these previous posts as I continue to work two days a week dealing with the aggravation of electronic medical records, coding, and insurance company nonsense. I don’t need to work but I still enjoy helping our patients with their healthcare needs and I also try to help them navigate the health insurance challenges.

It is interesting to me that there seems to be little interest in whether or not insurance company executives or hospital administrators are overpaid or if we are the college tuition bank for their children.

While talking to our family medicine practice manager last year, I noticed stacks of documents on her desk. Since everything is done online these days, it is rare to see stacks of documents on the desks of our office staff anymore.

When I asked her what they were, she told me that they were hard copy insurance claims that had not been paid since the first of the year. The estimated amount for the unpaid claims was over $60,000 at that time and this had been going on for about seven months.  

I was told that the hard copy claims were because the insurance company kept denying the claims that were submitted online. Even though our staff had made sure that the online claims were accurate, they were still not being paid. Consequently, the hard copies were printed and triple checked and submitted again.

The insurance company involved was Cigna. 

Since we are an independent family medicine practice, every dollar counts in order to keep the lights on, staff paid, and other daily necessities. We do not rely on a large hospital system to cover the cost of unpaid insurance claims for over seven months. 

Furthermore, there is not an endless budget to pay staff to keep checking and resubmitting insurance claims. I know this is part of the Cigna (and any insurance company) plan. Delay long enough hoping that offices quit submitting claims for the money owed to them.

Consequently, our physicians go unpaid for some months due to this shortfall and because they are looking out for the staff. Unlike many other medical specialties, primary care providers do not always have the luxury of fancy cars or multiple vacation homes. 

This problem with Cigna is not just isolated to our group. Medical offices around the country have been shortchanged by Cigna for years. Cigna claims it was due to a glitch in their software, but the problem has persisted since 2022. 

Based on this lack of payment, Cigna had a class-action lawsuit filed against it by patients and physicians in 2022. However, a federal judge ruled in 2024 that neither the American Medical Association or other organizations representing physicians can be a part of the lawsuit.

I am unable to find any online information regarding a new class-action lawsuit being filed by patients against Cigna.

Gee, who is going to win when the dust settles? The lawyers overseeing the class-action lawsuit. Who is going to lose? The patients and independent medical practices.