Investigative Reporter Katie LaGrone explains the little known, rarely talked about consequence of medical insurance denials- doctors walking away from performing certain procedures.
“IT’S BECOME ALMOST IMPOSSIBLE TO DO THIS WORK ANYMORE.”
For more than 20 years, Dr. Andrew Rosenthal has helped make breast cancer patients in Palm Beach County feel whole again.
“Starting back in 2004 that’s almost entirely what I did, all types of different reconstruction after breast cancer for patients,” he said.
But a few years ago, the board-certified plastic surgeon who currently leads Florida’s Society of Plastic Surgeons joined a growing number of surgeons in America who are putting down their scalpels and walking away from reconstructive surgeries.
“It’s become both regulatory and financially almost impossible to do this type of work anymore,” Rosenthal recently told us from his office in Boynton Beach.
“There are plenty of plastic surgeons that want to continue to do this work, but we can’t get the insurance contracts to do it, or it takes us years to get paid,” he said.
THE HIDDEN COST OF AMERICA’S HEALTH INSURANCE CRISIS
Call it the hidden cost of America’s for-profit health insurance crisis.
Experienced surgeons in private practice who are saddled by insurance overreach, over-regulation and, what they describe as, arbitrary patient denials and unnecessary payment delays are ditching insurance networks altogether.
Opting, instead, for the smooth lines of cosmetic-centered practices and cash-paying customers.
Watch Dr. Rosenthal discuss regulatory issues with insurance companies:
Doctor discusses insurance issues
“It took me two years one time to get paid for a patient for breast cancer reconstruction. That just doesn’t work, and the poor patients are left sort of holding the bag on this,” he said.
“They’ve completely handcuffed us,” said Dr. David Halpern, a triple-board certified plastic surgeon in Tampa.
Dr. Halpern also gave up performing breast reconstruction surgeries after spending years fighting insurance companies and battling for laws to better protect breast cancer patients from unfair insurance denials.
“You start throwing in all these denials, denials, denials, and the cost of claiming goes up and the reimbursements go down,” he said. “It’s an impossible model to keep up with.”
Halpern showed Investigative Reporter Katie LaGrone a claim for one of his last breast cancer patients in 2022 that remains unpaid to this day.
Watch Dr. Halpern’s talk about insurance issues:
“They have completely handcuffed us”
It’s no secret burnout among physicians is high and job satisfaction is low.
While it’s unknown how many physicians are giving up procedures over insurance frustrations, according to a 2023 article from the American Medical Association, it’s all contributing to a worsening doctor shortage in America that could surpass 100,000 in the next ten years.
“My own mom had breast cancer,” said Dr. Rosenthal. “I would love to go do breast reconstruction again,” he said.
But for now, it’s just not profitable for these surgeons doesn’t appear to be changing anytime soon.
“I don’t feel guilty. I know that I’ve done thousands of breast reconstructions in my time,” said Dr. Halpern.
“I see patients who I did reconstruction on 20 years ago who now need further surgery and can’t get it from me anymore and that’s a real shame. That makes me very sad,” Dr. Rosenthal said.
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