Leslie Howard

I am a mother of a daughter and an aunt of 4 nieces. I am also a healthcare attorney who represents plastic and reconstructive surgeons every day. Many of my clients are out-of-network surgeons who treat breast cancer patients and reconstruct their breasts after the horrible physical disfigurement of a mastectomy and who help them through the emotional trauma that accompanies their surgery.

To me, these are not ordinary surgeons. They are talented and immensely skilled board-certified plastic and reconstructive surgeons who are an integral part of a woman’s personal journey. They are surgeons who put the patient’s health first and operate after receiving authorization from an insurance company, often with no idea how much they will be compensated by an insurance payor, if at all. Despite the unknown, they continue to treat. These surgeons are part of what the insurance companies, and their lobbyists, blame as the problem with healthcare today.

Over the last couple of years, I have discussed with these surgeons, the political climate towards changing health insurance. I observed, for the first time, a sweeping movement of doctors giving up and leaving their craft behind, only to perform self-pay cosmetic surgery. In addition to the frustration of these providers, according to the Association of American Medical Colleges, the United States will see a shortage of up to nearly 122,000 physicians by 2032. This, in my mind, is the beginning of the end of access to skilled surgeons in all disciplines of medicine.

I heard from a physician that he is worried that when he grows older there will be no highly trained physicians to take care of him. Sadly, I walked away with fear for myself, my family, my friends, women, and this country. Thankfully, I don’t have breast cancer, but I am afraid that one day when I or someone I know needs to turn to a specialized doctor, there will be nowhere to turn to.

For nearly a decade, I have been in the trenches with insurance payors, fighting on behalf of providers (and patients) to get fair reimbursement. I have personally witnessed the business practices and patterns of insurance payors nationwide, and with each year that passes, they make the practice of medicine virtually impossible, unaffordable, and unbearable by constantly creating barriers for physicians to get paid fairly and timely and for patients to have ‘medical security’. Oftentimes, I have seen this process overwhelm resources and take upwards of two years before a claim is paid fairly. Yet, insurance companies continue to report revenues and income in the billions of dollars with top executives receiving annual compensation in the millions.

Admittedly, at times, I have had to manage the expectations of some clients in what they deemed fair reimbursement against their outlier billed charges. But overwhelmingly, I have been appalled by the diluted benefits that the insurance companies sell as health insurance, especially “out-of-network” benefits, and what ultimately the consumer believes is their passage to peace of mind for serious illnesses, only to face, in times of need, unimaginable financial liability due to the low reimbursement rates (“allowed charges”) made by the insurance payors.

The ‘No Surprise Act’ is due to go into effect January 2022, with the federal government expected to publish regulations clarifying and expanding upon the provisions over the summer. The Act, which is designed to protect patients from surprise medical bills, is considered a major development in resolving billing and coverage disputes between insurers and providers. The impact of this legislation on the future of medical care in the United States remains to be seen. Only time will tell if a fair balance can be created between the insurance companies and the medical profession in the reimbursement of services for medical care in this country such that the predicted shortage in care will begin to swing in the other direction.

Leslie Howard

About the Author: Leslie Howard, Esq. is the Co-Founder and Managing Partner of Cohen Howard, LLP, a NJ based healthcare reimbursement solutions law firm devoted to representing providers in reimbursement matters throughout the United States. She is also the Founder and CEO of Howard Healthcare Group an Advisory and Management Services Organization providing practice management and administrative support services to physicians, hospitals and ambulatory surgery centers nationwide.