The "hassle factor": What motivates physicians to manipulate reimbursement rules?

Rachel M. Werner, George Caleb Alexander, Angela Fagerlin, Peter A. Ubel

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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. Results: 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 (χ 2=7.56; P=.02), the appeals process length (χ 2=8.53; P=.01), and the severity of the medical condition (χ 2=71.10; P

Original languageEnglish (US)
Pages (from-to)1134-1139
Number of pages6
JournalArchives of Internal Medicine
Volume162
Issue number10
StatePublished - May 27 2002
Externally publishedYes

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Insurance
Physicians
Postal Service
Deception
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

The "hassle factor" : What motivates physicians to manipulate reimbursement rules? / Werner, Rachel M.; Alexander, George Caleb; Fagerlin, Angela; Ubel, Peter A.

In: Archives of Internal Medicine, Vol. 162, No. 10, 27.05.2002, p. 1134-1139.

Research output: Contribution to journalArticle

Werner, Rachel M. ; Alexander, George Caleb ; Fagerlin, Angela ; Ubel, Peter A. / The "hassle factor" : What motivates physicians to manipulate reimbursement rules?. In: Archives of Internal Medicine. 2002 ; Vol. 162, No. 10. pp. 1134-1139.
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