Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies.
They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight.
Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies
We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient.
This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country
@Acconomics My payouts at SM stopped as well, until I give more personal information. Do you know of anyone got payments after sending info? Should fly down and be the canary in the coal mine? Cheers.