Are my doctors taking advantage of my insurance?

Shots are wearing joints and bones so it’s not always the best option.

Doctors don’t benefit much from patients with Medicaid and Medicare, that’s why many don’t accept patients with state sponsored health insurances.

When I broke my neck in February, I had thousands of $$ worth of images. They revealed a mass on my thyroid. Everyone said "you'll have to have a FNA". (Fine needle aspiration/biopsy). I got referred to Ear Nose and Throat. I had to have an ultrasound to image the thyroid to insure the mass hadn't gone anywhere. I had to have an examination so a PA could explain why I needed an FNA, and then I had to schedule the biopsy. While they are doing the biopsy, they are working with a live ultrasound image. After all that $$ spent on MRIs, one might think the ulatrasound and examination for the FNA were superfluous. Also, when I went for my 6 week followup after the broken neck, neurology ordered an Xray in the am. In the afternoon, I was seen by a PA who didn't seem interested in my neck at all. All she wanted to do was talk about the spinal stenosis she noted on the hospital MRI. I got billed for $1200 for that evaluation, and out of pocket was $500 because they weren't sure my insurance would pay for it. About 6 weeks later, they refunded me $360 without explanation and showed me that my insurance did ultimately cover the spinal stenosis evaluation. Here is the deal on spinal stenosis. It's not whether the image shows narrowing of the spinal column that counts. It's whether you are symptomatic. I wasn't symptomatic and hopefully never will be. The ENT I was referred to settled with the Justice Department in 2020 to the tune of $10 million. Do they seek to over bill? You bet your extra kidney they do.

I had the FNA at the local hospital instead of the ENT. It found me to be in need of further testing. I said go ahead and do it. They say they don't do it and would have to refer me back to ENT.
ENT wants to do their own FNA. I just wasted $290 copay having a standard procedure done, but ENT will have to do their own. I visited again with ENT. They set up an appointment for
another FNA. I asked two different people at the ENT office what my copay was. They said there was no charge. I had my PCP refer me to an ENT out of this cachement area. I now have an appointment
early next month. It is a bit of a drive, but if I have to start this process all over again, I am going to give another medical center the opportunity. Oh, and my local ENT found out I was leaving the area.
I got a bill for the second consultation yesterday. The one two people told me there would be no charge.

The shots are about $3 thousand without insurance. I got an MRI done and it showed a lot more issues than the X-ray did. So I finally got a shot yesterday. My copay was $10. Maybe the doctor just wanted to try pt first before billing Medicare. Idk

I was listening to NPR last month and they were interviewing NY Congressman (Dem) Suozzi. He said that doctors work for the hospital, the hospital works for the insurance agency, and the insurance agency works for the hedge fund. The statement reflects a significant, widely documented transformation in the U.S. healthcare landscape, where corporate entities, private equity firms, and insurance giants are increasingly controlling medical practices, hospitals, and clinical decision-making.

Here is a breakdown of the structural shifts described in the statement:

1. Doctors Work for the Hospital (and Corporations)
The model of independent physician practice has rapidly declined.

• Employment Shift: More than 77% of U.S. doctors are now employed by hospitals, health systems, or other corporate entities.
• Private Equity/Insurance Owners: Over 20% of doctors are employed specifically by private equity firms or insurance companies, rather than traditional hospitals.
• Impact: This shift is driven by high operating costs and administrative burdens, but results in doctors losing autonomy over clinical decisions, often under pressure to increase patient volume.

2. The Hospital Works for the Insurance Agency
While hospitals traditionally operate independently, they are heavily dependent on—and sometimes controlled by—insurance entities.

• Negotiation Power: A handful of insurers control 94% of the commercial insurance market, allowing them to determine reimbursement rates and define "in-network" care, which dictates hospital revenue.
• Vertical Integration: Insurers are increasingly acquiring hospitals and provider groups. For example, UnitedHealth Group's Optum is a massive employer of physicians and operates alongside its insurance arm.
• Utilization Review: Insurers act as managers by requiring prior authorization for treatments, effectively limiting care to manage costs, which forces doctors to work within insurer-driven guidelines.

3. The Insurance Agency Works for the Hedge Fund/Private Equity
Private Equity (PE) firms and alternative asset managers are increasingly buying insurers and healthcare companies to secure steady revenue streams.

• PE Takeover: Private equity firms are purchasing insurance companies and reinsurance businesses to gain access to large pools of capital (premiums) that they can invest in their own strategies.
• Profit Motivation: PE firms use high debt to purchase healthcare entities, placing the debt on the acquired hospital or practice. They then cut costs and increase revenue through high-volume, high-revenue procedures to pay down debt, often prioritizing shareholder return over patient care.
• Investment Firms: Large managers like Apollo Global Management, Blackstone, KKR, and Carlyle have all recently bought stakes in, or entirely acquired, insurance businesses.

In Summary: The trend represents a "financialization" of healthcare, where the ultimate goal moves from patient care to maximizing revenue for shareholders and investors.

• Private Equity and Health Insurers Acquire More Physicians than ...
  Health insurance plans and their subsidiaries have spent billions acquiring physician practices over the last five years. » United...
  
  It's not just health care.Hedge funds are buying up houses, veterinary clinics, you name it and they want to control it.