11/05/2025
💭 Let’s Talk About Health Insurance and Why It Feels So Backwards:
After 17 years as a medical provider, most of that time spent working inside large hospital systems, I never really knew what went on behind the scenes with insurance reimbursements. The hospital handled it all, and I just saw patients.
Now that I own my own private practice, I finally see what insurance actually pays providers. And honestly, it’s shocking.
☝️ Here’s the truth:
Insurance companies like UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield negotiate huge contracts with large hospital systems. Those hospitals receive much higher reimbursement rates for the exact same services that smaller, independent clinics like mine provide.
Why? Because hospitals have more leverage. They bring in large volumes of patients, so they can demand higher payments. Independent clinics do not get those same deals. We get what’s left.
And here’s something most people don’t realize: in those big systems, providers are often limited to 10 to 15 minutes per patient because that is all the insurance reimbursement allows for. That is not enough time to really listen, connect, and provide quality care.
Here’s how it works when you come in for a visit:
I see you and submit a claim to your insurance company.
Even if that claim lists a charge of $1 million, the insurance company only pays what they have pre-negotiated, maybe $100.
That amount is the “allowed” payment, and it is paid either by your insurance company or by you, depending on your plan.
If you receive a bill, it is usually because of one of these reasons:
• Your deductible has not been met yet.
• You owe a coinsurance percentage.
• You have a copay due.
• Your provider was out of network.
Now think about this:
You pay monthly premiums just to have insurance. Often, that is hundreds of dollars every month, whether it comes out of your paycheck or directly from your bank account. Then, you still have to pay a deductible before insurance actually starts helping.
So you are paying to have insurance, and then paying again to use it.
To make matters worse, insurance companies still decide what medications, tests, or imaging will be covered, even when your provider knows what is best for you.
It is confusing, frustrating, and unfair for both patients and providers.
We are all paying more and getting less, while the large systems and insurance companies continue to win.
Make it make sense. 🩺
At Imbue Health, we will always do our best to work within your insurance plan and advocate for your care, but it is important to understand how the system impacts both patients and providers.
www.imbuehealthnc.com
