In this episode, we’re joined by Ron Howrigon, President of Fulcrum Strategies, who specializes in guiding doctors through the complexities of insurance policies. Ron shares his unique journey from working on the insurance side to advocating for physicians and patients against unfair industry practices. We dive into the challenges of prior authorization, insurance denials, and their impact on physician burnout. Ron sheds light on the incentives driving insurance companies and the reasons behind coverage battles, while offering thoughtful solutions to improve the system for patients and health care providers alike.

Among the highlights in this episode:

01:17: Ron explains his career shift from working for major insurance companies to founding Fulcrum Strategies, motivated by his personal experience during his child's birth

03:15: Ron describes the main focus of his work: helping physicians negotiate fair reimbursement terms with insurance companies and address issues like prior authorization

06:04: Ron highlights common problems physicians face, including retroactive denials and patients being unable to afford out-of-pocket costs despite having insurance

08:14: Ron discusses the motivation behind insurance companies’ tactics, explaining the profit-driven nature of the industry and how it conflicts with patient care needs

09:49: The conversation shifts to the challenges of managing chronic disease within the insurance system, with Ron explaining the adverse selection and cost issues insurers face

11:01: Zoe Rothblatt, Director of Community Outreach at GHLF, shares her personal experience with biologic medication costs, highlighting the financial burden on chronically ill patients

13:46: Ron offers his perspective on potential solutions, including the possibility of universal health care and reforming the insurance industry's approach to prior authorization

15:29: The discussion addresses the need for accountability in the insurance industry, with Ron suggesting that medical directors be held to the same standards as prescribing doctors

18:49: Ron offers a message of resilience and hope, encouraging patients and physicians to continue advocating for policy change and better care

19:57: What our hosts learned from this episode

Contact Our Hosts

Steven Newmark, Chief of Policy at GHLF: snewmark@ghlf.org

Zoe Rothblatt, Director of Community Outreach at GHLF: zrothblatt@ghlf.org

A podcast episode produced by Ben Blanc, Associate Director, Digital Production and Engagement at GHLF.

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