The Provider Insurance Revenue Study

Since the beginning of the COVID-19 pandemic in March, 2020, Physicians and other medical Providers have taken devastating hits to their practice revenues. Most of the losses are due to doctors being forced to curtail elective procedures and office visits as Americans were ordered to stay home during the height of the national health emergency.

As Physicians were able to return to work in the early Summer, even if only partially, many had to adjust to the newer medical practice of telehealth, and the lower revenues that came with it. The Centers for Medicare & Medicaid Services (CMS) gave assurances to Physicians that Medicare would reimburse telehealth encounters at 100% of the office visit rate. But private Payers were under no such obligation. Across the country, Physicians are reporting that they're being reimbursed at about 70% of an office visit rate despite the fact that telehealth requires both resources and expertise to implement effectively, and each encounter takes up to twice as long as an office visit.

Adding to financial hardships, Physicians across the nation are reporting that legitimate insurance claims are being held up and denied by the insurance companies at a higher rate than ever, cutting off the cash that they need so desperately. As of June 1, only half of Physician practices say they have enough cash to stay open for another month.

In just 2 months in the spring of 2020, over 45 million Americans lost their jobs and for many, that also meant the loss of their employment-related health insurance. Despite shedding a massive number of members from their rolls, health insurance companies are actually predicting record profits for 2020. The pandemic it seems, is very good indeed for the health insurance business. Private investors and executives are taking huge dividends and bonuses out of the system just at a time when US healthcare needs a vast new investment of healthcare resources into the system. The good fortune of a few individuals and corporations comes at an as yet untold expense to American society.

The formula for insurance company success in a pandemic only happens one way. By keeping member premiums, delaying payments, and denying treatment authorizations, the large health insurance companies are taking advantage of the profound misfortunes of both doctors and patients during a national health emergency.