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The "Hassle Factor": what motivates physicians to manipulate reimbursement rules?

Publication ,  Journal Article
Werner, RM; Alexander, GC; Fagerlin, A; Ubel, PA
Published in: Archives of internal medicine
May 2002

Some physicians are willing to misrepresent clinical information to insurance companies to circumvent appeals processes. Whether characteristics of appeals processes affect the likelihood of misrepresentation is unknown. This study sought to determine the relationship between the likelihood of a successful appeal, appeals process length, and severity of the health condition and physicians' willingness to sanction deception.A random sample of 1617 physicians was surveyed by mail to assess their willingness to accept an insurance company restriction, to appeal the restriction, or to misrepresent the facts to an insurance company to obtain coverage for a patient.Most respondents would appeal (77%) rather than accept (12%) or misrepresent (11%) regarding a restriction on medically necessary care. Physicians' decisions were related to the likelihood of a successful appeal (chi(2) = 7.56; P =.02), the appeals process length (chi(2) = 8.53; P =.01), and the severity of the medical condition (chi(2) = 71.10; P<.001). A small but significantly larger number of physicians chose to misrepresent the facts to an insurer as the appeals process became more cumbersome. Among physicians asked about severe angina, their decisions were particularly affected by the hassle associated with appealing, being more likely to choose to misrepresent the facts to the insurer than to appeal as the hassle increased.Physicians are more willing to sanction deception when the appeals process is longer, the likelihood of a successful appeal is lower, and the health condition is more severe. Changes in the difficulty of appeals processes may ease the tensions physicians face regarding patient advocacy and honesty.

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Published In

Archives of internal medicine

DOI

EISSN

1538-3679

ISSN

0003-9926

Publication Date

May 2002

Volume

162

Issue

10

Start / End Page

1134 / 1139

Related Subject Headings

  • United States
  • Referral and Consultation
  • Primary Health Care
  • Negotiating
  • Motivation
  • Middle Aged
  • Male
  • Low Back Pain
  • Logistic Models
  • Insurance, Physician Services
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Werner, R. M., Alexander, G. C., Fagerlin, A., & Ubel, P. A. (2002). The "Hassle Factor": what motivates physicians to manipulate reimbursement rules? Archives of Internal Medicine, 162(10), 1134–1139. https://doi.org/10.1001/archinte.162.10.1134
Werner, Rachel M., G Caleb Alexander, Angela Fagerlin, and Peter A. Ubel. “The "Hassle Factor": what motivates physicians to manipulate reimbursement rules?Archives of Internal Medicine 162, no. 10 (May 2002): 1134–39. https://doi.org/10.1001/archinte.162.10.1134.
Werner RM, Alexander GC, Fagerlin A, Ubel PA. The "Hassle Factor": what motivates physicians to manipulate reimbursement rules? Archives of internal medicine. 2002 May;162(10):1134–9.
Werner, Rachel M., et al. “The "Hassle Factor": what motivates physicians to manipulate reimbursement rules?Archives of Internal Medicine, vol. 162, no. 10, May 2002, pp. 1134–39. Epmc, doi:10.1001/archinte.162.10.1134.
Werner RM, Alexander GC, Fagerlin A, Ubel PA. The "Hassle Factor": what motivates physicians to manipulate reimbursement rules? Archives of internal medicine. 2002 May;162(10):1134–1139.

Published In

Archives of internal medicine

DOI

EISSN

1538-3679

ISSN

0003-9926

Publication Date

May 2002

Volume

162

Issue

10

Start / End Page

1134 / 1139

Related Subject Headings

  • United States
  • Referral and Consultation
  • Primary Health Care
  • Negotiating
  • Motivation
  • Middle Aged
  • Male
  • Low Back Pain
  • Logistic Models
  • Insurance, Physician Services