May 23, 2017

Battered Provider Syndrome


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11/17/2008
Brian S. King
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Many have heard of “battered spouse syndrome” or "battered person syndrome." That’s when a person in a relationship is abused by their partner but never quite develops the backbone to do what is necessary to put a stop to the abuse. Sometimes the battered person blames herself for the abuse. Other times the person excuses the partner’s abuse by blaming circumstances supposedly beyond the abuser’s control. But the primary characteristic of the disorder is that, despite the fact that any rational person would walk away from the relationship or demand change in the abuser’s behavior, the abusee ends up submitting to continued abuse. It’s a cycle that repeats itself over and over. Sometimes the battered spouse ends up dead. But even if that extreme is never reached, this cycle of behavior is never a characteristic of a healthy relationship. It degrades both individuals involved. The counterpart to these concepts that I regularly see in the healthcare industry involving healthcare providers and commercial payers, usually insurers, is what I call “battered provider syndrome.” In the relationship between healthcare provider and payer for those services, the payer calls the shots. Often payers deal fairly and honestly with providers and their relationships are healthy. But payers commonly take advantage of the leverage they perceive they have over a provider to delay payment, provide bogus denial reasons, fail to communicate, ignore appeals of denied claims, cut procedural corners in handling appeals, demand that discounts be given by providers for no good reason, etc. The list of ways in which payers abuse providers goes on and on. It happens in the context of managed care contracts as well as in indemnity insurance policies. More amazing to me than the regular abuse I see payers giving out to providers is how often I see providers simply take the abuse without responding in a way that clearly indicates the payer's behavior is unacceptable. Time after time providers simply take what reimbursement they are offered by payers and walk away. Their willingness to accept just about any justification payers present for why something less than the amount due under an insurance policy or managed care contract should be paid constantly surprises me. So long as providers are unwilling to hold payers accountable for their abusive reimbursement practices, the provider guarantees those practices will continue. Every time a provider agrees to accept less than the amount both parties know full well should be paid, that provider teaches the payer an important lesson: you can cheat me out of money I’m owed and there will be no negative consequences. That is the essence of battered provider syndrome.

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