For over 12 years I have worked for my husband in his Plastic Surgery Practice in Birmingham, Alabama. I began by managing his Cleft Lip/Palate Clinic which included fighting with insurance companies to cover the medically necessary services for these special children born with facial deformities. For ten years I fought tooth and nail to get insurance companies to “approve” surgery for children born with facial deformities. Did you hear me? I had to fight to get these surgeries “approved.” Often times, the insurance companies would “authorize” the surgery only to have the claim denied after the surgery had been performed. We would then have to follow the insurance company’s protocol of filing a “letter of appeal” only to get that brushed under their mat hoping the surgeon’s office staff would forget thus allowing for the time to run out for the claim. After numerous phones calls, faxes of medical records, sitting on hold listening to how wonderful they are, the claim would eventually be mailed as “paid” only no check would be enclosed and the “Patient Responsibility” would list the full amount of the claim minus the insurance company’s “contractual not-allowed.” The patient’s family would call and the insurance company would tell them the doctor’s office didn’t submit a “clean claim,” and when we called the insurance company they gave us the run around. It was a classic pit-the-patient-against-the-doctor scam. It worked. The last time this happened to my husband, he never got paid. The patient’s family was convinced by the insurance company that his office “didn’t file a clean claim.” The insurance company claimed the “elective surgical procedure” had been approved under a clause of the patient’s insurance policy where they were financially responsible.
This is how it has been and will be for doctors and insurance companies. Somehow the people of the USA think Obamacare will guarantee them healthcare. Not so fast. Allow me to shed light on where this is going and why I say: 2018- Your Doctor is a Plastic Surgeon.
Patients always gripe about their “co-pay” and “patient responsibility” with their doctors. First thing everyone needs to understand is that physicians have a contract with these insurance companies they are providers for that requires them to collect co-pays and patient responsibilities from the patients at the time of service. Patients are required to pay these fees as outlined in their contracts they have with their insurance providers. These co-pays are part of the payment, if not all, the physicians agree to accept from the insurance companies. Since the passing of Obamacare, insurance rates have skyrocketed, including the out-of-pocket expenses for patients, and additional taxes are burdening basic medical supplies at the expense of the physician and/or medical facility. What this means for physicians is that their private practice costs have also skyrocketed, reimbursement remains a challenge and un-fixed, and their patients are no longer able to afford their co-pays. Given the insurance payment challenges physicians have been up against for decades, physicians have been “crossing the specialty line” for many years changing their specialties from general surgery, family practice, dermatology, OB-GYN, to “cosmetic surgery.” This is where I stepped in 2010 with ThePlasticTruth.com exposing these rogues with fly-by-night liposuction training in Vegas then showing up Monday morning with a hang-over and a sign that reads “Now offering lipo.” These rogues are ever increasing as the true insurance regulations are ignored by Obamacare resulting in fewer primary care physicians and more “cosmetic surgeons.”
It’s common knowledge in the Plastic Surgery Industry that a majority of the plastic-surgery-gone-wrong stories plastered in our media are due to the procedure being performed by one of the rogues who are not board certified by the American Board of Plastic Surgery. As outlined on ThePlasticTruth.com, these rogues have created their own board certifications as a pathetic attempt to justify their lack of formal education for the specialty they practice. This deception has been recognized by states such as Florida with a “Truth in Medical Marketing Act.” Even my OB-GYN offers Botox and artificial fillers as a “French Fry” business to supplement his income. This is what my husband refers to as a “perfect storm” in the Plastic Surgery Industry meaning both a storm surge of Plastic Surgeons, and also a lack of other medical health providers offering real medical services other than cash paying cosmetic services to squeeze out pathetic insurance reimbursements. Imagine going to your cardiologist for bypass surgery and the doctor asking you “would you like lipo with that?”
Bottom line is that physicians are being squeezed more and more by insurance companies as they place more of the financial burden on the patients. The cost of physicians to file insurance claims and fight for these payments is merely an additional practice expense to the already squeezed private practice physician. Even the Society for Hospital Medicine recommends physicians could “provide Botox services at cosmetic parties in the evenings” as a way to supplement their income. The storm surge of cosmetic surgeons had already been on the rise prior to Obamacare, and now post-Obamacare sans real insurance reform gives Americans “the perfect storm.” The American Academy of Cosmetic Surgeons (home of these physicians whom are not board certified by the American Board of Plastic Surgery) states on their website they had the “highest attendance in the Academy’s history with more than 900 medical professionals” for their 2013 annual meeting. The internet is littered with articles discussing the decrease in physicians for the years to come. Physicians from coast to coast are faced with early retirement or seeking alternative ways to generate income outside the exam room. Many predict the only place to find medical care will be the major universities thus foreseeing overcrowded waiting rooms and longer waiting times with less time to speak to the physician. And, you think it is lean now. Just wait, or go see your Real Board Certified Plastic Surgeon for that head cold.
From time to time, state medical boards are faced with the task of regulating these rogue physicians in response to the plentiful complaints of damaging cosmetic surgery results performed by these rogues. Recently, the Medical Board of the State of Alabama made such an attempt to regulate in-office liposuction procedures in the name of “patient safety.” While it’s all a great idea, it doesn’t address the root of the problem. These medical boards can legislate how the procedure is performed as far as anesthesia safety is concerned, but they cannot address the permanent contour deformities and tissue loss these patients are given as a result of their cosmetic physician not really knowing how to do the procedure. These are things real plastic surgeons learn in their plastic surgery residencies.
Surveys conducted by Athena Health and Sermo show “79 percent of physicians are less optimistic about the future of medicine, 66 percent indicated that they would consider dropping out of government health programs, and 53 percent would consider opting out of insurance altogether” (Daniel Palestrant, M.D., “Why Physicians Oppose the Health Care Reform Bill,” Sermo, April 8, 2010). It’s that last number of 53% which strikes my attention. What would these doctors do? Will they only accept cash for medically necessary services or are they considering crossing over to the rogue cosmetic surgery side? Considering the high insurance premiums, co-pays, and deductibles, is it financially feasible for a patient to pay cash to see their doctor for sinusitis? Doctors already know the answer to that question is ‘no.’ No, Mr. Obama, patients are not likely to keep their doctor. Instead their doctor will be glad to see them for a facelift or liposuction.
Recent reports of restaurant chains and movie theatres decreasing employee hours so as to avoid health benefit programs should be more than alarming to patients and physicians alike. Physicians need patients and patients need physicians. These employees will be at the mercy of a government based health plan, with fewer doctors willing to accept them as a patient. “If 66% of physicians are considering dropping out of government health plans, if only half actually do we would have an incredible shortage of doctors to see Medicare and Medicaid patients. The last resort is your local university training program, but don’t expect to see an attending physician,” states my husband, Dr. Paul Howard who spent years on the faculty at the University of Alabama Birmingham as an attending physician. A recent report by The Texas Medical Association shows two alarming grafts of the decline of physicians accepting Medicaid and Medicare. Texas physicians are dropping out of these government insurance plans steadily since 2000. This is only the beginning. The real Medicare deal hasn’t even hit yet.
Obamacare only addresses the Medicare system for physician payment. Private insurance companies already have a long history of cat-and-mouse with their providers as mentioned at the beginning of this article. With no real health insurance reform protecting physicians, they will continue to drop out of accepting not only government insurance plans, but private ones as well and the “cosmetic surgeon” trend will continue with the likes of me on their coat tails calling them out for the rogues they are. This will leave us with the Real Board Certified Plastic Surgeons who most have already adapted to the poor insurance reimbursements and are actually qualified to practice according to their board certification. Let it also be known that most Real Plastic Surgeons completed a general surgery residency before going on plastic surgery residencies, making them quite qualified to help out with those head colds. By 2018, Obamacare will be at its finest and the number of physicians opting-out of accepting insurance plans can only predict to be devastating, and they will all be labeling themselves as either a Plastic or Cosmetic Surgeon. Secure your Real Board Certified Plastic Surgeon today.