If you have ever been on the search for a new doctor in Huntsville, AL, then you know that the process can be frustrating at best to absolutely dreadful at worst. From primary care to specialty physicians, who you choose to take the helm of your needs can make all the difference. You may have a list of requirements that you deem absolutes, but one probably takes priority: health insurance.

Health insurance isn’t a topic that makes the rounds at a party, and for good reason. It’s complex, nuanced, and if we are being fully transparent, esoteric. Seriously, how many people do you know who can list off all the ins and outs of health insurance from top to bottom? Americans are frustrated with health insurance, so much so that most do not switch providers from year to year even though their needs are not being met or they may have a better choice in coverage.

Health Insurance Literacy

Health insurance literacy is a big issue in the United States. As challenging as navigating health insurance is, many do not have a grasp on the terms of their policies.  The Kaiser Family Foundation conducted a study on health insurance terminology and understanding in 2019, and the results are fascinating. Basic concepts such as copays, monthly payments, provider network, and deductible, were answered correctly by at least seventy-percent of those surveyed. However, more complex ideas such as health insurance formulary yielded fewer correct responses.

Confused By Your Health Insurance Yet?

Are you confused by your health insurance yet? Most of us know a little about our insurance but few understand the whole. Let’s go back to the number one consideration when selecting a physician: Do they accept my insurance? Chances are you’ve found the perfect physician only to check with your health insurance provider and find they are not in-network? Why is that? Why do doctors and health care facilities not accept every insurance provider on the market? The answer to this question is not cut and dry.

There are multiple reasons why Innova Primary Care, for example, does not accept all insurances. As always, renewing health care from the inside out is one of our main objectives. One way we seek to accomplish this is through accessible information for our patients and the general public alike. Let’s take a closer look at why doctors and practitioners may choose to not work with a given insurance provider.

Health Insurance Provider Contracts

To begin with, doctors must enter into a contract with health insurance providers. Did you know that for every insurance company out there, a physician must complete paperwork and meet credentialing criteria in order to be considered an “in-patient” provider with a given insurance company? This process can take weeks to complete AND must be done for each payer. This means that for every insurance company a physician works with, a long drawn out process must first occur.

It is important to note that every insurance company has different requirements. While Medicare is simple and standardized, insurance carriers are not. Health insurance companies do not make it easy for providers. They have their own systems and requirements. There is no standardization. Payers (the insurance companies determine who they will contract with based on factors such as discounts and availability of service). They also consider other credentials such as board certifications and education. Again, there is no standard here. Payers have the ultimate say in who they will work with.

Healthcare continues to evolve from year to year. You may have noticed the trend towards hospital-owned healthcare facilities. Now insurance companies are staking their claims by purchasing clinics of their own in direct competition to the physicians and hospital systems they cover. This is fodder for biased care and something Innova Primary Care does not agree with. We seek to minimize our involvement with insurers who are seeking to monopolize the health care system by running their own clinics.

Who Gets Covered?

Did you know that every insurance company decides on its own what it will cover and what it will not? Your physician has recommended a procedure. Your insurance provider, however, refuses to pay. A friend of yours needs the exact same treatment from the exact same physician, yet her insurance approves. Why is this?  Again, there is no standard here. Each insurance company has specific protocols and rules concerning the services they will cover and those they will not. Patients are often not aware of this fact, and it can be quite a shock to be turned down by their insurer care they need.

Finally, the reality is that physicians must pay bills too. Most insurance companies try to pay as little as possible for services. For example, some insurance companies that Innova Primary Care works with pay approximately half per visit compared to others for an office visit. This means that we must see twice as many patients to generate the same amount of revenue. Our aim is to treat our patients as we want to be treated, and unfortunately, there are some insurers that do not allow us to do this. We have to be selective about who we partner with for the good of our patients and our business.

Navigating the complexities of health insurance is a challenge for physicians as well as patients. Innova Primary Care longs for the day when all doctors are able to treat their patients without jumping through hoops to provide the best service. However, that day is not here yet. Until then, our promise to you is that we will remain vigilant and continue to do our part to provide the best patient-centered care to you.