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The American College of Rheumatology (ACR) can Help Combat Insurance Frustrations

James R. O’Dell, MD  |  Issue: April 2012  |  

James R. O'Dell, MD
Pictured, from left to right, are Angus Worthing, MD, chair of the Affiliate Society Council; Rudy Molina, MD, chair of the Insurance Subcommittee; James O’Dell, MD, ACR president; and Charles King, MD, chair of the Committee on Rheumatologic Care.

I was reviewing my own medical insurance policy the other day and it occurred to me that medical insurance has become a dirty term. From industry or from individuals’ or patients’ perspectives, I don’t hear anyone that has favorable remarks about insurance. It is an understatement to say that the communication on the ACR advocacy list serve lately has focused specifically on insurance-related matters. When it comes to dealing with insurance companies, the rules seem to change frequently and always in an arbitrary and capricious way. The ACR is trying its best to protect rheumatologists, but we need your help!

Insurance and Administrative Burdens

Health Affairs published an article in 2009 titled, “What Does it Cost Physician Practices to Interact with Health Insurance Plans?”1 According to the article, “physicians reported spending three hours weekly interacting with plans, nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that that national cost to practices of interaction with plans is at least $23 billion to $31 billion per year.”

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Think of how much time and energy could be saved if insurance companies would stop or lessen these administrative burdens, and how much more fun it would be to practice. We might even get to spend a little more time with some of our favorite patients—imagine that. The above article discusses how the costs of interacting with insurance plans had risen in two years—and that was back in 2009. It would be interesting, and almost certainly depressing, if a follow-up study would be completed. This might be a good project for the ACR Insurance Subcommittee because it relates directly to rheumatology—if the ACR can afford the SSRIs for the committee.

ACR Insurance Subcommittee Working for You

The ACR Insurance Subcommittee was started a couple of years ago and is currently chaired by Rudy Molina, MD. This subcommittee interprets policies and sends letters to and/or contacts insurance companies when it receives complaints from the membership. Since its inception, we have seen improvement in the communication between the insurance companies and the ACR. Some insurance companies are now asking for our input before developing policies, or at least welcoming our input once we give it to them.

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