So You Want Dr. Mortimer To Contract With Your Managed–Care, For–Profit Medical Insurance Company, Do You Now?
We understand that you have recently switched to a medical insurance company which is a managed care – that is, for–profit – company. It might be:
- Aetna, which was ranked by the American Association for Justice as one of the Top Ten Worst Medical Insurance Companies in the United States. According to St. John's College alumnus Phillip Mattera (Aetna: Corporate Rap Sheet – 2016) Aetna had its origins in the 1850s when slaves were deemed property (– and many insurance companies insure property, right?). When the slave died, Aetna's legal predecessor reimbursed the slaveowner for the death of his "property." In 1999, a California jury awarded $116 million in punitive damages to the widow of a man whose death from stomach cancer was alleged to have been caused by the refusal of an Aetna subsidiary to approve treatment which had been recommended and approved by Aetna's own doctors! Dr. Mortimer recalls that, in 2001, Dr. Mortimer's office manager spent fourteen months in repeated phone calls and letters to Aetna before Aetna finally reimbursed Dr. Mortimer for the professional medical services he had already provided to one youngster. Or, perhaps your new managed care company is:
- Beacon Health Options, which, in 2015, was fined $900,000 by New York Attorney General’s Office because Beacon Health Options denied coverage of psychiatric services to its medical insurance policy–holders at twice the rate of other general medical claims. And guess what health system contracted with Beacon Health Options in 2017? – Providence Health! Or, perhaps your new managed care company is:
- Cigna, which was rated in 2015 as The Worst Medical Insurance Company in the United States by Fiscal Times. In both 2015 and in 2018, Cigna was identified by the American Consumer Satisfaction Index as one of the most hated companies in the United States. Or:
- EBMS; or
- First Choice; or
- HealthNet; or
- Humana; or
- LifeWise; or
- Magellan Behavioral Health; or
- MODA. Do note that all of Dr. Mortimer's patients who have MODA medical insurance policy have thus far had zero coverage/reimbursement for seeing Dr. Mortimer. Thus, patients with MODA medical policies must pay for Dr. Mortimer's professional medical/psychiatric services (and for any medications he prescribes) entirely out–of–pocket. Or:
- Molina. Dr. Mortimer recalls that in the case of one of his teen patients with Molina insurance, not only did Molina deny any coverage/reimbursement for Dr. Mortimer's professional medical services, but Molina also denied pharmacy benefits coverage for any prescription written for this boy by Dr. Mortimer (– since Dr. Mortimer refused to contract with Molina). More outrageously, Molina forbade the boy's parents from even paying cash for their son's medication (since the prescription was written by Dr. Mortimer)! Or:
- ODS. Dr. Mortimer recalls that in 2003, ODS delayed reimbursement to Dr. Mortimer for 150 days after the date of the patient's office visit! Or:
- Optum (a subsidiary of United HealthCare – see below); or
- PacificSource. Based on how seeing how poorly PacificSource treated his PacificSource–contracted patients over the past 20+ years, Dr. Mortimer and his office manager Jill have concluded that PacificSource uses its "no coverage for behavioral problems" medical insurance police clause to deny medical benefits coverage for any psychiatric condition. Or:
- Providence Good Health Plans. While Providence claims to be a non–profit organization, Dr. Mortimer has observed that in one of its recent annual reports, Providence reported accruing 800 million dollars in "excess revenue." Over the past thirty years of dealing with Providence Health administrators, Dr. Mortimer has concluded that Providence Health administrators must subscribe to the following policy: "The more frequently we deny medical/psychiatric benefits coverage for our policy holders (and their families), then the more 'non–profitable' we can be!" Dr. Mortimer suspects that the reason that the entire staff of psychiatrists at Providence’s Sacred Heart Medical Center in Spokane, Washington resigned in June 2015 was because these over–worked psychiatrists could no longer tolerate working for a system which treated them as if they were a certain kind of "property" frequently found in the South in the 1850s, and who were insured by Aetna's legal predecessor [see above]. Or:
- TriCare/CHAMPUS, which has delayed reimbursement to Dr. Mortimer 12 months after the patient's date of service with Dr. Mortimer; or
- UMR; or
- United BehavioralHealth (UBH) – which is a subsidiary of United HealthCare (see below); or
- United HealthCare, which was rated "The Worst Insurance in the United States" by ThinkAdvisor. Among United HealthCare's recurring legal problems, Dr. Mortimer notes that in September 2021, the U.S. Department of Labor and New York Attorney General found that United Healthcare and its subsidiary United Behavioral Health had – since 2013 – repeatedly violated the federal Mental Health Parity and Addiction Equity Act of 2008. To settle this lawsuit, United HealthCare agreed to pay $16 million ["chump change" comments Dr. Mortimer] in restitution and penalties to consumers, the federal government, and the state of New York. Or:
- ValueOptions, which has repeatedly delayed (e.g., by first demanding that Dr. Mortimer complete voluminous and unnecessary paperwork about his patient) and stalled (up to six months) on paying for Dr. Mortimer's claims. When ValueOptions finally did pay his claims, it was only $40 per office visit – with the patient's family then paying the balance on the account. Or:
- Washington State Apple Care (also known as offering Washington State "coupons") to which Dr. Mortimer will only respond with "no comment." Or:
- Washington State Health Care Authority – to which Dr. Mortimer will only scowl and mutter under his breath. Or:
- Some other, execrable, for–profit or otherwise Satan–controlled, managed care medical insurance company.
And you are asking Dr. Mortimer for the favor of contracting with your managed care medical insurance – primarily so that:
- you can save money on the cost of the professional medical services which Dr. Mortimer provides to you or your family, and/or:
- you can save money on the cost of prescription medications which Dr. Mortimer prescribes for you or your family.
Observing how “managed care” companies operate over the past thirty years, Dr. Mortimer has concluded that if the administrators were honest, a “managed care” insurance company's CEO would say something like this:
“We are managing the medical costs incurred by you – the medical policy holder and your family – so that we can maximize our profits [after all, we are a “for–profit” company], even if our medical coverage policy restrictions worsens your health – or even kills you or your family member. We really don’t care about you or your health – we have hired enough attorneys to craftily compose medical insurance policies to protect us from losing substantial lawsuits. Heck, paying that 50 million dollar settlement as United HealthCare did in September 2021 is about one hour's profit for us. It's the cost of doing business. Who cares? Even if we get caught and fined by the courts, we still make an enormous annual profit! We have also hired enough attorneys to compose contracts with our physicians so that our company will be protected from huge lawsuits which might result if the patient dies due to our delaying medical benefits coverage or other criminal activity – leaving the contracted physician to be sued for our malfeasance, misfeasance, or nonfeasance. Furthermore, we remain optimistic that – for the indefinite future – we can force enough naive physicians to contract with us at our steeply discounted rates to make sure we remain very profitable, indeed. Lastly, in order to maximize our profits even further, we have policies in place to delay, prevaricate, and stall on paying on every claim submitted by any physician foolish enough to contract with us.”
Please be aware that if Dr. Mortimer were to contract with your for–profit, managed care medical insurance company without first negotiating the specific terms of your managed care insurance company's standard contract, then Dr. Mortimer can guarantee that the financial reimbursement rates for his professional medical/ psychiatric services would be steeply discounted (– that is, if Dr. Mortimer is ever reimbursed at all for the professional services which Dr. Mortimer were to provide to you or to your family member). This discounting of Dr. Mortimer's posted professional medical fees would mean that he would then have to work even more hours per week to pay for his fixed overhead expenses (Jill's salary, rent, telephones, office equipment, office supplies, salaries, malpractice insurance, credit card fees, accounting fees, etc.). This also means Dr. Mortimer would then have less time to spend outside of work for his family and friends, and less time to read, exercise, and obtain adequate rest/sleep. This unenviable situation is probably why the entire psychiatrist staff at Providence’s Sacred Heart Medical Center in Spokane, Washington resigned in June 2015 – they realized that they were being treated like a particular category of "property" which had been insured by Aetna's legal predecessor in the South in the 1850s [see above].
This situation as outlined above is, as Dr. Mortimer summarizes: "Something like this I simply cannot allow. First of all, do be aware that I will unwilling to sign any contract with a for–profit, managed care organization which prioritizes the managed care organization's profit ahead of what is – in my medical opinion – the most safe, appropriate and/or medically necessary care for my patient. Secondly, I am unwilling to sign any contract with any for–profit managed care organization which causes my professional medical services being devalued. And lastly, if I were to contract with your for–profit, managed care medical insurance plan without first negotiating the terms of its standard contract, I would then relive the nightmare of "the for–profit, managed care experience" – analogous to what prison inmates mean by 'picking up the soap.' No thank you!"
Dr. Mortimer continues: "I have already 'picked up the soap' after contracting with PacifiCare, United Behavioral Health, and Providence Good Health. I assure you: I have learned my lesson! Among many psychiatrists, at least one of the for–profit managed care companies listed above has a reputation for repeatedly dishonoring its contracts with both its policyholders (and the policyholder's family members) and with its contracted physicians. In my case, one or more of the above managed care companies: (1) repeatedly delayed reimbursement for my professional medical services for up to twelve months after the patient’s date of service; and (2) reimbursed me at a rate less than the rates which were promised to me by written contract. Contract again with United Behavioral Health? I'd prefer another edition of the Spanish Inquisition!"
Dr. Mortimer continues: "Since you are asking me to sign a legal document written by your for–profit, managed care insurance company’s team of what some would assert are Satan–spawned attorneys, then I must first review the contract with my attorney to make certain that I secure a written agreement with your for–profit, managed care medical insurance company which protects me from again being mulcted."
Dr. Mortimer concludes: "In order to minimize the number of times that a for–profit managed care insurance company cheats me again, I must insist on being paid fairly for the associated costs to my professional corporation (the P.C.) – and to my soul – which are likely to result from contracting with your for–profit, managed care, and Satan–controlled medical insurance company. Thus, I have two conditions which must first be met before I will even consider contracting with your for–profit, managed care medical insurance company:
- You agree to reimburse Dr. Mortimer (via his Professional Corporation (Dale B. Mortimer, M.D., P.C.) for the costs of all legal fees Dr. Mortimer (or his P.C.) incurs which are associated with negotiating the final terms of Dr. Mortimer's contract with your for–profit managed care medical insurance company; and
- You agree to pay Dr. Mortimer (via his Professional Corporation (Dale B. Mortimer, M.D., P.C.) a $10,000/year “administrative fee” to compensate Dr. Mortimer for the anticipated frequent and long hours of aggravation that he will most certainly again suffer as the result of signing a contract with your for–profit managed care medical insurance."
Dr. Mortimer is sincerely sorry to learn that you now have medical "coverage" through a managed care, for–profit insurance company. You have Dr. Mortimer's sincerest sympathies, and he wishes you "Good luck!" with finding an experienced and competent psychiatrist who been foolish enough to have signed a contract with your new, for–profit, managed–care medical insurance company. The good news is that Dr. Mortimer has observed that usually after a year having one of the above managed–care medical insurance policies, patients switch back to medical insurance carrier which is more transparent, responsible, and ethical.