Business Insight presented by Arlington Dermatology Lessons From the Past! You know that I always recommend early intervention as the best method of attacking any problems, medical or non-medical as a matter of fact. It worked again. Last column informed you about some significant changes involving insurance participation and related to the decision to terminate us from multiple networks. We acted immediately upon receiving the message. We knew that it was purely administrative and truly silly reason that did not involve our performance in any respect. We heard from many of our patients about how upset they were. Many were in the middle of the 'insurance year' preventing them from making any changes until the next open enrollment. Our actions were not only immediate; they also involved ethical background of our network participation and ultimate the effects of our potential termination. We did it with full force and it worked. The decision was nullified. It means that we will continue being a part of the networks that were initially restricted. We will have to make some modifications to our referrals but in no form or shape these modifications will compromise medical care of our patients. So, it is a win and worries can be put away. Early intervention and strong and forceful reactions brought positive results, but we also reflected on the whole event, thinking about how our healthcare system is broken Dema individual person seeking coverage your fate is dependent on luck. Medicare part B operated directly by the Social Security administration is the only plan with guaranteed coverage regardless of your medical history, with the largest network of hospitals and doctors, and a set fee schedule updated annually and regulated by Congress. Yes, it might pay less than private insurers, but it guarantees your coverage. It offers reasonably low deductible and complex. The whole issue of contracting and pays 80% of all approved expenses. 94% with multiple networks, hundreds of plans under many insurances, set of benefits that limit access of patients to proper care, and inability to trust any arbitrators or representatives in regard to selecting plans that truly fit patients' needs, all of those challenges make the insurance not only hardly comprehended but also expensive. The complexity of utilization costs money. It involves hundreds and thousands of people 'designing' plans and setting the automated computer programs to follow algorithms executing restricted benefits, deductibles, covered and non-covered services, and networks of participating providers. Every year, these new insurers, newly develop programs confusing practically everybody dealing with them: patients, doctors, brokers, claims processors, and more. The goal is always the same: deliver the least possible benefits for the smallest cost and collect the highest possible premium. If you work and get the group plan, you may be protected better because your employer may have higher purchase power. But if you are an of collected premium funds are returned to the patients through the payments for medical services. That compares to less than 68% for the same in the case of private insurance, with their complicated designs. Many patients select so called Medicare substitutes, sometimes called Medicare part C, which have nothing to do with the real Medicare. Usually, they do it under the pressure of very aggressive sales from the private insurance industry and without fully understanding how these private plans work. They are promised additional services for less than the price, and they are happy until they need medical care, especially specialty care. Then, their enthusiasm disappears when they learn about all limitations and challenges with approval. This time, our own challenging event ended well. But we reflect and wonder when it will surprise us again with another challenge and will we be able to resolve it again? Michael Bukhalo, MD Arlington Dermatology 5301 Keystone Court Rolling Meadows, IL 60008 Tel. 847 392 5440 | www.arlingtondermatology.net Business Insight presented by Arlington Dermatology Lessons From the Past ! You know that I always recommend early intervention as the best method of attacking any problems , medical or non - medical as a matter of fact . It worked again . Last column informed you about some significant changes involving insurance participation and related to the decision to terminate us from multiple networks . We acted immediately upon receiving the message . We knew that it was purely administrative and truly silly reason that did not involve our performance in any respect . We heard from many of our patients about how upset they were . Many were in the middle of the ' insurance year ' preventing them from making any changes until the next open enrollment . Our actions were not only immediate ; they also involved ethical background of our network participation and ultimate the effects of our potential termination . We did it with full force and it worked . The decision was nullified . It means that we will continue being a part of the networks that were initially restricted . We will have to make some modifications to our referrals but in no form or shape these modifications will compromise medical care of our patients . So , it is a win and worries can be put away . Early intervention and strong and forceful reactions brought positive results , but we also reflected on the whole event , thinking about how our healthcare system is broken Dema individual person seeking coverage your fate is dependent on luck . Medicare part B operated directly by the Social Security administration is the only plan with guaranteed coverage regardless of your medical history , with the largest network of hospitals and doctors , and a set fee schedule updated annually and regulated by Congress . Yes , it might pay less than private insurers , but it guarantees your coverage . It offers reasonably low deductible and complex . The whole issue of contracting and pays 80 % of all approved expenses . 94 % with multiple networks , hundreds of plans under many insurances , set of benefits that limit access of patients to proper care , and inability to trust any arbitrators or representatives in regard to selecting plans that truly fit patients ' needs , all of those challenges make the insurance not only hardly comprehended but also expensive . The complexity of utilization costs money . It involves hundreds and thousands of people ' designing ' plans and setting the automated computer programs to follow algorithms executing restricted benefits , deductibles , covered and non - covered services , and networks of participating providers . Every year , these new insurers , newly develop programs confusing practically everybody dealing with them : patients , doctors , brokers , claims processors , and more . The goal is always the same : deliver the least possible benefits for the smallest cost and collect the highest possible premium . If you work and get the group plan , you may be protected better because your employer may have higher purchase power . But if you are an of collected premium funds are returned to the patients through the payments for medical services . That compares to less than 68 % for the same in the case of private insurance , with their complicated designs . Many patients select so called Medicare substitutes , sometimes called Medicare part C , which have nothing to do with the real Medicare . Usually , they do it under the pressure of very aggressive sales from the private insurance industry and without fully understanding how these private plans work . They are promised additional services for less than the price , and they are happy until they need medical care , especially specialty care . Then , their enthusiasm disappears when they learn about all limitations and challenges with approval . This time , our own challenging event ended well . But we reflect and wonder when it will surprise us again with another challenge and will we be able to resolve it again ? Michael Bukhalo , MD Arlington Dermatology 5301 Keystone Court Rolling Meadows , IL 60008 Tel . 847 392 5440 | www.arlingtondermatology.net