They are fudging when they are pressed for time and when they want to avoid the Byzantine, infuriating business of making appeals and filing forms. It s not just a matter if deceptive doctors or unfeeling payers. We set up the game that everyone knows about and no one has acknowledged or addressed as openly as now. Historically, we trained doctors to think of patients one by one. Physicians look for a way around the rules.
Payers tighten the rules.
Then physicians search for the wiggle room. These days the game escalates on and on, with both sides warily eyeing each other. It s waged overtly over paperwork and denials, documentation and appeals. We never meant to have a system in which you get what your doctor fights for or fudges for. We never meant to have a system based on subversion rather than discussion.