Comments on SICKO Michael Moore movie.
ssdr18
Posts: 121
This is my comment to him and wondered what others thought:
6/20/07
Dear Mr. Moore:
Congratulations on your documentary, ‘Sicko’. As a physician in private practice for 18 years in New York City, I feel a need to comment.
First off, you barely uncovered the actual corruptness of the health insurance industry in this country. We all know about the denials made by insurance companies. They have a predetermined guideline and anything that does not meet their criteria are denied. In order for a reversal they require an appeal. This is actually not corrupt. The guidelines are documented prior to someone signing up for a certain plan.
Are you aware however about the actual scams and shenanigans they pull. In 1997 are you aware that Oxford did not pay physicians for about 6 months. Each time a physician would call regarding an outstanding claim, they were told by a customer service representative that the check had been sent out. Check numbers and actual dates of the checks were given. They would then follow up with a statement that the check must have been “lost in the mail”, and they will stop payment on it, however it would take approximately 90 days before another check could be reissued. I can tell you personally hundreds of my checks were “lost in the mail” , and thousands of dollars were in arrears. After six months I had to hire legal representation and threaten to sue so that I can pay the bills needed to continue to operate my medical practice. The American Psychiatric Association finally did step in and the matter was resolved.
In 2003 Oxford pulled another shenanigan in order to obtain money. They decided to conduct an audit in the New York City area. They asked for notes on 110 random patients, and chose 5 random dates of service. They had us (over 300 mental health professionals were involved in this audit; including psychiatrists, psychologists, and social workers) photocopy these notes, of course on our dime and time, and mail them. They then had some unknown person review the notes, and decide whether the billed session was appropriately coded and billed for. They would make a rash decision based purely on what words were included in the note. For example, if a patient seen for both weekly psychotherapy and medication management did not have the word medication mentioned in that progress note, even if that word or the drug name were written in the medication record kept in the chart, a conclusion was made that that visit should have been billed at a lesser reimbursement rate. They then came up with an amount that was inappropriate billed, multiplied that amount by the total number of patient visits seen by all Oxford patients over a 10 year period, and came up with some astronomical number they demanded refunded to them. Confidentiality matters were not taken into account, and highly confidential reports were sent out to strangers at the insurance company at their demand. Individual practitioners had to hire their own legal counsel, as we do not have a union, to defend against this. Eventually this whole witch-hunt was dropped, but that was after thousands of dollars were spent individually on legal counsel, and preparing of the paperwork.
Do you also realize that in the last 15 plus years, our fee per visit have not been increased. We are receiving the same reimbursement or a lower fee for a 45 minute session than we received in 1993. For example, when I started working with Cigna Health Plans they were paying $120 for a 45 minute session. In the late 1990’s this fee was reduced to $95. My own individual health insurance plan however continues to increase at a greatly inflated rate. It seems to increase at about $60 to $75 per monthly payment or almost $1000 per year. Doctors have not seen a penny of this money.
Other tactics they use in order to avoid payment, although legal, is just to keep people on hold, sometimes up to an hour or more. On one very sad occasion, several years ago, I needed to have the hospitalization of a patient approved before I could send him to the hospital. This patient I felt potentially could be suicidal, as his condition was progressively worsening over the course of a week, and having treated him for the six months prior, knew this change in mental state could potentially be serious. I continued to try to engage him, while listening to the music when kept on hold; a difficult feat when speaking with an acutely depressed and potentially suicidal patient. Finally, after one hour on hold, someone picked up; I reviewed the case and hospitalization was approved. During that time however this patient decided he did not wish to go into the hospital. His family was called and they did not wish for him to go as well. They came to pick him up and agreed to stay with him and he made an appointment for the following day. The following morning I received a call informing me that this patient had indeed jumped in front of a train, leaving behind a wife and two small children. No, there was no law suit against me, or the insurance company for that matter, and I cannot guarantee if he went to the hospital he would have agreed to stay or what the outcome would have been. I only know that before I made that phone call he agreed to go, and it was while I was on hold so long he changed his mind. Without family support or his agreement, I was not able to commit him involuntarily. This long hold time or the tactic of transferring to an average of 4 departments before getting to the proper medication approval department, is also how the companies minimize approval of certain of the more expensive second tier medications.
We clearly do have a crisis at hand. Despite the lack of change or decrease in gross income received, expenses continue to rise. Speaking personally, my office rent went up $1000 per month when my lease expired in 1999. My malpractice insurance is higher. The reason so many doctors have either stopped accepting insurance or stopped practicing is all because of this crisis. In addition, if one needs to see so many more patients per unit time in order to meet expenses, that you compromise integrity and medical abilities, then why practice medicine. This is why so many of my colleagues have stopped practicing after studying for more than 10 years. If one is fortunate to be able to sustain a full time practice, and earn a living without accepting insurance, yet in turn be able to practice good medicine, then that is what will be done. It is why if you have money in this country, you will receive good healthcare. That is the shame.
The movie unfortunately did present some fallacies in its depiction of healthcare in Europe. It is not true that patients don’t wait to see a doctor there but rather there is a priority wait list based on need. I had a few patient’s that actually moved to England and flew back to see me as they were not able to obtain their medication there and were put on a three month waiting list to see a psychiatrist.
I do not have an answer to this crisis, however at this time I do believe this is an absolute crisis. What I do predict is that many of our more intelligent children will steer away from a career in medicine. How unfortunate. We depend on the minds of the intellectually gifted to come up with creative ideas to help prolong life and in healing. I will say that I love being a physician, and it has been my interest from a young age. I never became a physician to become rich, and presently live a very meager life. The idea of someone else paying and taking care of all the business aspects of my practice, paying me a salary, yet letting me practice medicine as an individual practitioner, not in a clinic setting, is not without appeal. I would hate however for our medical system to become solely clinics, as in general the care then becomes substandard.
Perhaps as a first step then, there should be serious investigation of the insurance companies as they stand, as well as much greater regulation. Perhaps their should be a reasonable and customary health insurance fee, as they impose on individual practitioners. Perhaps then health care will become affordable and available to a great many more people. In essence, maybe the goal should not be to make people on Wall Street richer.
In closing, I do want to thank you for your extraordinary effort in at least attempting to open up the eyes of many to this crisis. Maybe the next time around you can focus even a little more on the corruptness.
Respectfully yours,
6/20/07
Dear Mr. Moore:
Congratulations on your documentary, ‘Sicko’. As a physician in private practice for 18 years in New York City, I feel a need to comment.
First off, you barely uncovered the actual corruptness of the health insurance industry in this country. We all know about the denials made by insurance companies. They have a predetermined guideline and anything that does not meet their criteria are denied. In order for a reversal they require an appeal. This is actually not corrupt. The guidelines are documented prior to someone signing up for a certain plan.
Are you aware however about the actual scams and shenanigans they pull. In 1997 are you aware that Oxford did not pay physicians for about 6 months. Each time a physician would call regarding an outstanding claim, they were told by a customer service representative that the check had been sent out. Check numbers and actual dates of the checks were given. They would then follow up with a statement that the check must have been “lost in the mail”, and they will stop payment on it, however it would take approximately 90 days before another check could be reissued. I can tell you personally hundreds of my checks were “lost in the mail” , and thousands of dollars were in arrears. After six months I had to hire legal representation and threaten to sue so that I can pay the bills needed to continue to operate my medical practice. The American Psychiatric Association finally did step in and the matter was resolved.
In 2003 Oxford pulled another shenanigan in order to obtain money. They decided to conduct an audit in the New York City area. They asked for notes on 110 random patients, and chose 5 random dates of service. They had us (over 300 mental health professionals were involved in this audit; including psychiatrists, psychologists, and social workers) photocopy these notes, of course on our dime and time, and mail them. They then had some unknown person review the notes, and decide whether the billed session was appropriately coded and billed for. They would make a rash decision based purely on what words were included in the note. For example, if a patient seen for both weekly psychotherapy and medication management did not have the word medication mentioned in that progress note, even if that word or the drug name were written in the medication record kept in the chart, a conclusion was made that that visit should have been billed at a lesser reimbursement rate. They then came up with an amount that was inappropriate billed, multiplied that amount by the total number of patient visits seen by all Oxford patients over a 10 year period, and came up with some astronomical number they demanded refunded to them. Confidentiality matters were not taken into account, and highly confidential reports were sent out to strangers at the insurance company at their demand. Individual practitioners had to hire their own legal counsel, as we do not have a union, to defend against this. Eventually this whole witch-hunt was dropped, but that was after thousands of dollars were spent individually on legal counsel, and preparing of the paperwork.
Do you also realize that in the last 15 plus years, our fee per visit have not been increased. We are receiving the same reimbursement or a lower fee for a 45 minute session than we received in 1993. For example, when I started working with Cigna Health Plans they were paying $120 for a 45 minute session. In the late 1990’s this fee was reduced to $95. My own individual health insurance plan however continues to increase at a greatly inflated rate. It seems to increase at about $60 to $75 per monthly payment or almost $1000 per year. Doctors have not seen a penny of this money.
Other tactics they use in order to avoid payment, although legal, is just to keep people on hold, sometimes up to an hour or more. On one very sad occasion, several years ago, I needed to have the hospitalization of a patient approved before I could send him to the hospital. This patient I felt potentially could be suicidal, as his condition was progressively worsening over the course of a week, and having treated him for the six months prior, knew this change in mental state could potentially be serious. I continued to try to engage him, while listening to the music when kept on hold; a difficult feat when speaking with an acutely depressed and potentially suicidal patient. Finally, after one hour on hold, someone picked up; I reviewed the case and hospitalization was approved. During that time however this patient decided he did not wish to go into the hospital. His family was called and they did not wish for him to go as well. They came to pick him up and agreed to stay with him and he made an appointment for the following day. The following morning I received a call informing me that this patient had indeed jumped in front of a train, leaving behind a wife and two small children. No, there was no law suit against me, or the insurance company for that matter, and I cannot guarantee if he went to the hospital he would have agreed to stay or what the outcome would have been. I only know that before I made that phone call he agreed to go, and it was while I was on hold so long he changed his mind. Without family support or his agreement, I was not able to commit him involuntarily. This long hold time or the tactic of transferring to an average of 4 departments before getting to the proper medication approval department, is also how the companies minimize approval of certain of the more expensive second tier medications.
We clearly do have a crisis at hand. Despite the lack of change or decrease in gross income received, expenses continue to rise. Speaking personally, my office rent went up $1000 per month when my lease expired in 1999. My malpractice insurance is higher. The reason so many doctors have either stopped accepting insurance or stopped practicing is all because of this crisis. In addition, if one needs to see so many more patients per unit time in order to meet expenses, that you compromise integrity and medical abilities, then why practice medicine. This is why so many of my colleagues have stopped practicing after studying for more than 10 years. If one is fortunate to be able to sustain a full time practice, and earn a living without accepting insurance, yet in turn be able to practice good medicine, then that is what will be done. It is why if you have money in this country, you will receive good healthcare. That is the shame.
The movie unfortunately did present some fallacies in its depiction of healthcare in Europe. It is not true that patients don’t wait to see a doctor there but rather there is a priority wait list based on need. I had a few patient’s that actually moved to England and flew back to see me as they were not able to obtain their medication there and were put on a three month waiting list to see a psychiatrist.
I do not have an answer to this crisis, however at this time I do believe this is an absolute crisis. What I do predict is that many of our more intelligent children will steer away from a career in medicine. How unfortunate. We depend on the minds of the intellectually gifted to come up with creative ideas to help prolong life and in healing. I will say that I love being a physician, and it has been my interest from a young age. I never became a physician to become rich, and presently live a very meager life. The idea of someone else paying and taking care of all the business aspects of my practice, paying me a salary, yet letting me practice medicine as an individual practitioner, not in a clinic setting, is not without appeal. I would hate however for our medical system to become solely clinics, as in general the care then becomes substandard.
Perhaps as a first step then, there should be serious investigation of the insurance companies as they stand, as well as much greater regulation. Perhaps their should be a reasonable and customary health insurance fee, as they impose on individual practitioners. Perhaps then health care will become affordable and available to a great many more people. In essence, maybe the goal should not be to make people on Wall Street richer.
In closing, I do want to thank you for your extraordinary effort in at least attempting to open up the eyes of many to this crisis. Maybe the next time around you can focus even a little more on the corruptness.
Respectfully yours,
Post edited by Unknown User on
0
Comments
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Very good letter... My best friend is a podiatrist (and my Pearl Jam concert mate for the last 10+ years), and I have to get his input on the movie and see what he has to say about it too. My mother is an MRI tech and has some stories about the day to day issues with HMO's and insurance companies, but it's great to hear from stories from the accounting/reimbursement side of the issue.
I'm guessing that there are doctors that take advantage of the medicare/insurance payments and would resist any change, but the more people can expose how things really work, the better.
I just really don't know what the best solution is...My whole life
was like a picture
of a sunny day
“We can complain because rose bushes have thorns, or rejoice because thorn bushes have roses.”
― Abraham Lincoln0 -
Thanks for posting this. I've got a copy of the film and plan to watch it this weekend.0
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I can picture Moore's response:
Dear Viewer,
You claim to have seen my movie prior to it's screening. I'll see you in court.
Michael MooreI necessarily have the passion for writing this, and you have the passion for condemning me; both of us are equally fools, equally the toys of destiny. Your nature is to do harm, mine is to love truth, and to make it public in spite of you. - Voltaire0 -
This is what I've said all along - that the biggest problem is INSURANCE itself. It's in INSURANCE's best interest that costs are so high that everyone needs INSURANCE. Then when you have it, it's in their best interest to withhold payment as much as possible.
Let's get rid of it.The only people we should try to get even with...
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.0 -
know1 wrote:This is what I've said all along - that the biggest problem is INSURANCE itself. It's in INSURANCE's best interest that costs are so high that everyone needs INSURANCE. Then when you have it, it's in their best interest to withhold payment as much as possible.
Let's get rid of it.
Insurance companies take much more money from Americans, then any collection of service providers ever would. They take their cut and spread the rest among the corrupt.
The beneficiaries will not allow us to get rid of them.
Sadly the "beneficiaries" are not the policy holders.0 -
thank you for a doctors insight on the movie AND on the problem. i hear the movie didn't point out that cuba is a communist country and doctors don't get "paid" as we know it. everyone wants free healthcare but there's no such thing. someone must pay and if government supplies healthcare; the taxpayers pay. not only for themselves but for the non-taxpaying population. since madicare doesn't pay for your type of services; you can expect a dramatic drop in patients because socialized healthcare won't cover it either. people can expect to be treated the same as our seniors are treated.
people need to be more careful about what they ask for; they just may get it.0 -
Socialized health care is the way to go. I can understand people with the selfish attitude about not paying for anyone else in life....but it's seriously messed up when an insurance company can totally destroy someone's entire existence and just because they can (and often do).
Do you think you're fully covered and safe right now?....think again...
Insurance companies make shit up (just to screw you) on the fly.
Having "car type" insurance for your health coverage is nuts. You just know you're going to get bent over at some point.
The first rule of insurance is: you always get screwed at some point with insurance no matter what.
The countries that have socialized health care....take a look a them are they burdened by health care costs?
I know most, if not all, doctors want to work in a socialized system where they can actually help people out of instinct...most likely the reason they became doctors in the first place...Progress is not made by everyone joining some new fad,
and reveling in it's loyalty. It's made by forming coalitions
over specific principles, goals, and policies.
http://i36.tinypic.com/66j31x.jpg
(\__/)
( o.O)
(")_(")0 -
RolandTD20Kdrummer wrote:Socialized health care is the way to go. I can understand people with the selfish attitude about not paying for anyone else in life....but it's seriously messed up when an insurance company can totally destroy someone's entire existence and just because they can (and often do).
Do you think you're fully covered and safe right now?....think again...
Insurance companies make shit up (just to screw you) on the fly.
Having "car type" insurance for your health coverage is nuts. You just know you're going to get bent over at some point.
The first rule of insurance is: you always get screwed at some point with insurance no matter what.
The countries that have socialized health care....take a look a them are they burdened by health care costs?
I know most, if not all, doctors want to work in a socialized system where they can actually help people out of instinct...most likely the reason they became doctors in the first place...
socialized medicine is just like insurance except the government takes the money from you to pay the premium; plus cover their administrative costs. my meds are $2623/month without insurance so if you want to pitch in i'll pm you the address.0 -
onelongsong wrote:socialized medicine is just like insurance except the government takes the money from you to pay the premium; plus cover their administrative costs. my meds are $2623/month without insurance so if you want to pitch in i'll pm you the address.
Apparently there is a difference....someone has made a documentary about it even
Are your meds worth that price? no...definitely not.
I will only ever live in a country with socialized health care.
I like how the lady in Sicko was able to pick up her asthma inhaler for $5 in Cuba but in America the exact same inhaler is over $120....
It's all a huge scam...Progress is not made by everyone joining some new fad,
and reveling in it's loyalty. It's made by forming coalitions
over specific principles, goals, and policies.
http://i36.tinypic.com/66j31x.jpg
(\__/)
( o.O)
(")_(")0 -
RolandTD20Kdrummer wrote:Apparently there is a difference....someone has made a documentary about it even
Are your meds worth that price? no...definitely not.
I will only ever live in a country with socialized health care.
I like how the lady in Sicko was able to pick up her asthma inhaler for $5 in Cuba but in America the exact same inhaler is over $120....
It's all a huge scam...
it's not the same medicine. the us has standards. if you buy 5mg of xxx in the us; it's 5mg. in mexico it could be 4mg or 6 mg. i bring this up because of a lawsuit against a doctor. the patient died and the family sued. the widow made the mistake of bringing the medication to court and the defence had it analized because it was from mexico. the dosage varried from pill to pill in the same bottle and the doctor was aquitted. the patients heart condition required an exact dosage and the patient didn't follow the doctors prescribed dosage.
what do you think happens to meds that don't meet quality control standards? they get sold to other countries without those strict standards. are you old enough to remember when all those defective condoms were sent to africa. their standards are lower.
also remember that $5.00 in cuba may be a days pay.
i have a med that has to be exact. 32.4 mg to be exact. anymore would kill me (over a few weeks) and less would throw me into seizures again. i'd rather pay for the top quality then play russian roulette buying it in another country.0 -
Less administrative costs combined with more participants paying in means cheaper premiums for you. No need to send your address. The government already has it.onelongsong wrote:socialized medicine is just like insurance except the government takes the money from you to pay the premium; plus cover their administrative costs. my meds are $2623/month without insurance so if you want to pitch in i'll pm you the address.0 -
RainDog wrote:Less administrative costs combined with more participants paying in means cheaper premiums for you. No need to send your address. The government already has it.
i beg to differ. it's more participants receiving healthcare. those that can pay in; are already paying in. look at medicare and medicaid. the taxpayers are already paying in and that system is so burdened. imagine another 280 million added to that system. the government would not only have to raise taxes but cut other services.0 -
RainDog wrote:Less administrative costs combined with more participants paying in means cheaper premiums for you. No need to send your address. The government already has it.
ps: more participants also means more paperwork and thus more administrative costs.0 -
The government would likely have to raise taxes. They may have to cut other services, but then again they may not. We could probably get by doing little of either, though, were we to audit how our tax dollars are being spent, while at the same time cutting back on our militaristic attitude.onelongsong wrote:i beg to differ. it's more participants receiving healthcare. those that can pay in; are already paying in. look at medicare and medicaid. the taxpayers are already paying in and that system is so burdened. imagine another 280 million added to that system. the government would not only have to raise taxes but cut other services.
The taxpayers you speak of are already paying in and paying into private insurance. Under a universal system, they'd only be paying the tax - which would be cheaper overall. Many companies would benefit, too, as they would no longer have to offer insurance as an incentive to their employees.0 -
Comparitively cheaper administrative costs, not overall cheaper administrative costs - i.e. a gallon of milk costs more than a half gallon, but the per ounce costs on the gallon are a lot less.onelongsong wrote:ps: more participants also means more paperwork and thus more administrative costs.0 -
I don't want the government in the healthcare business....or ANY business. It can't be trusted to run things correctly, efficiently, effectively or any other word ending with "ly" except poorly.The only people we should try to get even with...
...are those who've helped us.
Right 'round the corner could be bigger than ourselves.0 -
if the government takes over our healthcare would pay for physicians have to go down? I mean if they will be the ones paying, they would almost certainly expect physicians to take a pay cut as well, so we can make the health care affordable. In canada health care providers make roughly 50% less than in america, which is why some canadian physicians have practices in the states as well. Are we going to send our economy into a huge slowdown for the universal healthcare?make sure the fortune that you seek...is the fortune that you need0
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know1 wrote:I don't want the government in the healthcare business....or ANY business. It can't be trusted to run things correctly, efficiently, effectively or any other word ending with "ly" except poorly.
exactly. Also, I don't want a congress that has practically zero physicians in it making up policy that affects my health, unless the congress listens to those physicians and not to special interests. (that'll be the day)make sure the fortune that you seek...is the fortune that you need0 -
Not to play devil's advocate here, but why can't those physicians become special interests themselves?chopitdown wrote:exactly. Also, I don't want a congress that has practically zero physicians in it making up policy that affects my health, unless the congress listens to those physicians and not to special interests. (that'll be the day)0 -
RainDog wrote:The government would likely have to raise taxes. They may have to cut other services, but then again they may not. We could probably get by doing little of either, though, were we to audit how our tax dollars are being spent, while at the same time cutting back on our militaristic attitude.
The taxpayers you speak of are already paying in and paying into private insurance. Under a universal system, they'd only be paying the tax - which would be cheaper overall. Many companies would benefit, too, as they would no longer have to offer insurance as an incentive to their employees.
i can understand your point and it's a good one. but i can't get past the fact that medical costs will remain the same. a nerve conduction test will still cost $8K usd so the amount of additional taxes would have to equal that of private healthcare premiums. the additional healthcare recipients would have to raise the premium costs. i can't see how it wouldn't.0
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