Downstreaming: You Keep Using That Word

TLDR: Downcoding is like a zombie insurance scam that crawled out of its grave wearing a new name tag that says “fighting waste and abuse.” Cigna, Aetna, Anthem, Humana, and their friends at the greed table figured out that if they just rebrand theft as “efficiency,” no one goes to jail. Two decades ago, courts buried this exact scheme after doctors sued them for cheating. Now it’s back.

Cue Doug Henning:

When doctors bill for complex visits, insurers quietly downgrade them to cheaper codes. The doc does the work, the insurer keeps the money, and the patient ends up paying with time and stress. A twenty-five percent haircut per visit doesn’t sound like much until you multiply it across thousands of patients. Then it’s millions in “savings” extracted from care.

It’s the same racket that lets insurers “upcode” their Medicare Advantage plans to drain taxpayer dollars while “downcoding” real physicians to pad profits. The only consistent principle is greed. Every press release about “waste and abuse” translates to “we found another way to not pay.”

People have -been calling this out for years, fighting the same predators with the same tactics. They shouldn’t have to. Downcoding is financial assault dressed as policy reform. It steals from doctors and punishes patients, and it proves that corporate healthcare will always find a new way to reanimate the corpse of its worst behavior.

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SOURCE ➡️ https://healthcareuncovered.substack.com/p/downcoding-is-back-from-the-dead