Our students this summer had the opportunity to spend time in the cadaver lab reviewing anatomy/surgical techniques and also spent time in the sawbones lab learning about the various instruments/tools that we use as orthopedic surgeons to fix fractures.
Update: After several weeks of contacting BCBS and getting no response (or limited answers), they finally admitted they made a mistake and eventually returned the funds.
#BCBSDOBETTER!!!
Recently, I faced a $150,000+ clawback from Blue Cross Blue Shield—money that was already paid for services I provided several months prior. This isn’t just frustrating; it’s unsustainable for any private practice 🤯
3/5: These clawbacks are forcing many physicians out of independent practice, leaving patients with fewer options and increasing healthcare consolidation.
Physicians need fair reimbursement, clearer policies, and stronger protections against these retroactive take-backs.
2/5: Imagine running a business where you make decisions based on revenue received, only to have it ripped away long after the service was performed. No other industry operates like this, yet in healthcare, it’s routine.
1/5: Running a private practice is already an uphill battle—balancing patient care, rising costs, and an ever-changing insurance landscape. But nothing is more disruptive and infuriating than insurance clawbacks.
10/10 Delays spanning several months, as I’ve experienced, are unacceptable and highlight the need for reform in the healthcare reimbursement process!!
9/9 It’s imperative to address these systemic issues. While patients are held accountable for timely premium payments, insurance companies must also be held responsible for prompt and fair compensation to healthcare providers.
7/7 Such delays are often attributed to insurers’ tactics to minimize payouts and maximize profits.
In Texas, the Prompt Payment Act was established to protect healthcare providers from habitual late payments by insurance companies, imposing statutory penalties for such delays.
6/6 This problem is not isolated. A recent survey by the American Hospital Association revealed that 50% of hospitals have not been paid for claims >$100M or more for over 6 months, with some outstanding claims dating back to 2016.
4/4 Despite obtaining prior authorizations and promptly submitting operative reports immediately after surgeries, I am still awaiting payment for procedures performed six to nine months ago. 🤬
3/3 The actions were reportedly fueled by frustrations over claim denials/delays. This event has intensified discussions around “delay, deny, defend” tactics often used by insurance companies to postpone payments, reject valid claims, & defend their decisions to protect profits!