If you’ve walked out of a doctor’s appointment feeling rushed, confused, or dismissed, you’re not imagining it. Appointments that used to run thirty minutes now feel squeezed into ten. Bills arrive with line items that don’t add up. Denials come back on care your doctor specifically recommended. Most people quietly assume this is just how the system works now and leave it at that.
Reid Zeising, CEO of Gain Servicing, has spent years working at the intersection of healthcare access, complex claims, and medical finance. He talks to physicians across the country every day and sees the same pressures showing up in practice after practice. His view is that the frustration patients feel isn’t random. It has specific causes. And understanding those causes, he says, is the first step to navigating the system more effectively.
Your Doctor Is Under Pressure Too
When a visit feels rushed, the instinct is to take it personally. Zeising says it’s worth resisting that instinct.
Physicians, especially those in smaller or independent practices, are caught between rising costs and declining reimbursements. Labor costs have gone up. Real estate has gone up. Equipment costs have gone up. At the same time, what Medicare, Medicaid, and commercial insurers pay doctors for their services has been falling. “Medicaid reimbursements in general lose doctors’ money,” Zeising says. “They are not being paid profitably to see those patients.”
The result is a math problem that gets solved the only way it can: see more patients in less time. That’s why the fifteen-minute appointment has become standard. It’s not a failure of care on your doctor’s part. It’s a structural constraint.
“Every doctor that I know in any state wants to deliver care in the best interest of the patient,” Zeising says. “It is why they got into the business of medicine. They did not get in the business to deal with claims denials.”
He sees that stress firsthand, constantly. “I am in touch with healthcare providers every single day. They are sucked into two areas of the business, HR and finance, that they historically did not have to worry about as much, and that are creating tremendous stressors.”
One thing worth knowing as a patient: seeing a nurse practitioner instead of a physician isn’t a downgrade in care for many conditions. Zeising makes this point directly. “There are a number of nurse practitioners who are highly trained, very capable in many things, and you can get better efficiencies.” He acknowledges the instinct to want the physician specifically, noting that “our ego may say that we want to see that doctor because we believe he or she is the expert,” but says that instinct isn’t always warranted. For a wide range of visits, a nurse practitioner is fully equipped to deliver what you need.
The Number That Puts the Access Problem in Focus
A lot of coverage of the healthcare access crisis focuses on the 27 million Americans who are currently uninsured. That number matters. But Zeising is specific about how it plays out in practice, and why it drives up costs for everyone. People without coverage tend to end up in emergency rooms for conditions that have no business being there. “It is an incredibly inefficient and high-cost way of dealing with a cold or the flu or a scratch,” he says. “Those things can all be done at urgent care.” Emergency rooms are essential for accidents, for genuinely catastrophic events, and for patients who need monitoring and immediate intervention. But they were never designed to function as primary care, and a large portion of uninsured patients currently have no other option. “There’s a tremendous amount of savings that could be had,” Zeising says, “if we had more effective delivery of care for those who are uninsured.”
But Zeising points to a larger number that gets less attention: 100 million, his figure for Americans who have less than four weeks of savings. The reason the distinction matters is this: if you are in that group and you have a high-deductible plan, the coverage may not actually protect you. “A $10,000 deductible,” Zeising says, “might as well have three zeros on it. It might as well be talking about $10 million. It doesn’t matter. You can’t just come up with that kind of money.”
So when we talk about access to care, we are really talking about two overlapping problems. One is people who have no insurance at all. The other is people who have insurance that doesn’t function as a safety net when they actually need it. Both groups end up making the same calculation: avoid the doctor and hope for the best. And both groups end up with worse outcomes as a result.
When You Get a Denial, That Is Not the End
One of the most disorienting things that can happen in the patient experience is receiving a denial for care your doctor recommended. It can feel final. Zeising is clear that it isn’t.
A story worth knowing
Zeising described a scenario he’s seen play out: a patient goes to the hospital after thinking they might have had a stroke. The hospital wants to keep them overnight and has ordered an MRI. The insurance company denies the overnight stay.
“If a patient’s walking in and a doctor and the staff is saying, we’d like to monitor you overnight, now what does the patient do?” Zeising said. “You’re faced with a financial obligation. You’ve signed documentation that says if your insurance company doesn’t pay, you will pay for this bill. And now you’re thinking: how much does an overnight stay cost? I’m not doing that. And what if that just puts you at risk?”
It’s a situation that forces a financial calculation at exactly the moment you’re least equipped to make one.
The appeal process exists for situations exactly like this, and Zeising is direct about the need to use it. “Get the doctor to write the opinion that says it’s necessary and why. Submit it on time. Make that phone call. See what they say and be persistent.” He acknowledges it isn’t easy. “Many times it is denial that just leads to exhaustion, where we give up.” His advice is not to. “You do not have to take no for that answer.”
Own Your Health Records — Actually Own Them
Every time you visit a new provider and fill out the same intake paperwork you’ve completed a dozen times before, you’re experiencing something Zeising talks about often: the fact that health information in America is controlled by the institutions that generate it, not by the patients it belongs to.
Different practices use different electronic medical record systems. Those systems frequently don’t communicate with each other. Records get siloed or lost. The same test gets ordered twice because the new specialist doesn’t have access to what was done six months ago at a different office. “Complete waste of time transcribing that paper information into fields within a new EMR,” he says. “Not acceptable.”
His position is that a patient’s health information should belong to the patient, be accessible to them, and be shareable on their terms. That model doesn’t exist systemically yet. But you can start building a version of it for yourself.
Most providers are now required to give patients access to their records through a portal. Use it. After visits, download your notes, lab results, and imaging. Keep them somewhere organized. “When you get tests done, download them,” Zeising says. “Consolidate your medical records so that you start to keep a centralized total record of your health.” The payoff is real: less time re-explaining your history, fewer redundant tests, and better-informed conversations with every provider you see.
“You have much more control,” he says of the practice. It takes effort up front. It pays back later.
AI in Healthcare Is Already Here — Ask About It
Artificial intelligence is being used in clinical settings right now, mostly in areas like radiology and dentistry, where it can cross-reference findings and flag things that might otherwise be missed. “You’re seeing radiology and dentistry both making tremendous progress in analyzing by utilizing AI,” Zeising says. Many practices are testing it even if they don’t make a point of advertising it.
Zeising is direct about asking providers whether it’s part of their process. “What you should insist on is AI reviewing your medical records and the advice that the doctors are giving.” The reasoning is straightforward: doctors want to be accurate. “They want to be right. They want to know if they’ve missed anything. They’re not seeing you to be wrong, and they’re not seeing you to have something go wrong as a result of missing something.” AI doesn’t replace clinical judgment. But as a second-pass review on something complex, it’s a tool worth asking your provider about.
He’s also honest that the fully frictionless healthcare experience, where records flow seamlessly between providers, scheduling is automated, and denials are resolved without a fight, is more future than present. The people working in healthcare today are doing genuinely demanding work under real financial and operational pressure. Better technology will help close those gaps. It isn’t fully there yet.
Before You Need Care: The Practical Work
The most consistent theme in how Zeising talks about patient navigation is this: don’t wait until you’re in the middle of a health situation to figure out how your coverage works. Do it now.
If you’re insured through an employer, go to your HR department before anything goes wrong. Ask what your deductible is and when it kicks in, which providers are in-network, and what the process is if a claim gets denied. “Utilize your HR department at work,” he says. “Don’t be shy. Don’t wait for something to happen when you then have the stress of something happening and you’re not prepared.”
If you buy your own coverage through the marketplace, take the same care. “Don’t always look for the absolute cheapest per month cost,” Zeising says. For someone who is young and healthy and rarely uses care, a high-deductible plan may make sense. But if you’re managing a condition or expect to use your coverage, look at the full picture. “Maybe for a few dollars more, your deductible is actually coming down pretty significantly. Pay attention to that.”
On network: staying in-network matters more than most patients realize. Going out of network often means your spending doesn’t count toward your existing deductible. “Out of network is a separate bucket,” Zeising explains. “You’re not satisfying your existing deductible. You haven’t hit your benefits limits.” It’s one of the most preventable sources of unexpected costs.
Zeising also suggests building a working relationship with your doctor around the coverage question before something gets denied. “Talk to your doctors about the likelihood of it being approved, about whether they would be willing to write a letter if it’s denied,” he says. Having that conversation early, not mid-crisis, makes the appeal process far less overwhelming.
One more practical note on choosing providers: being steered toward an in-network doctor you don’t know isn’t necessarily a compromise. “Please don’t assume that just because it’s not the doctor that a friend or trusted family member recommended that it’s not gonna be quality care,” Zeising says. There are excellent physicians in every network. The goal is to find one, which may mean calling two or three offices, and not to mistake familiarity with quality.
Where Care Is Moving — And What It Means for You
One shift happening largely out of patients’ view is the growth of ambulatory surgery centers, or ASCs, which are physician-owned facilities where many procedures that used to happen in hospitals now take place. Zeising explains that this shift is driven directly by the reimbursement squeeze. As margins tighten in standard practice, physician groups have increasingly looked to own their own surgical facilities, capturing margins that would otherwise go to a hospital system.
For patients, there are two things worth understanding about this. First, outcomes at ASCs for a wide range of procedures have been strong. “Not all patients should be seen in a hospital,” Zeising says. “It is a very high-cost place to provide care.” His view is that high-risk patients who genuinely need hospital-level monitoring should be in hospitals, but that the assumption that a hospital setting is automatically better for everyone isn’t supported by the evidence. “Take your high-risk patients for whatever reason and keep them in the hospital,” he says. “And let’s not try to pretend that everybody’s a high-risk patient just to keep business in a hospital.”
Second, if you’re offered a procedure at an ASC rather than a hospital, it’s worth asking questions about the facility, the surgical team, and what your insurance covers in each setting. But it’s not automatically a reason for concern. ASCs are licensed, regulated, and for many procedures deliver equivalent care at meaningfully lower cost.
The Takeaway: Don’t Absorb the Frustration Passively
Zeising is not optimistic about the pace at which systemic change will happen. He’s candid that navigating the current system requires more effort from patients than it should. But his point is that the effort is worth making, and that giving up on an appeal, on consolidating records, or on learning your plan costs more in the long run than the effort of engaging.
“Please don’t sit back and just do nothing but be frustrated,” he says. “It is very frustrating. But receiving quality care and getting better is the most important thing. Sticking with a system and believing a denial is okay just out of exhaustion will get you nowhere.”
And in the same breath, he doesn’t want people losing sight of what the system does well. “We have the greatest research hospitals in the world,” he says. “We have a fantastic healthcare system with wonderful doctors, dedicated nurses, and practitioners all throughout the country wanting to help patients.”
He’s also pointed out calls to replace it entirely. “Those that call for single payer systems that replicate Canada or the UK, please be careful what you wish for,” he says. “If you’re in need of a procedure and the question that you’re asking yourself is, am I going to live for the time that it’s going to take for me to actually get that procedure, that is a whole different level of stress that I wish upon no one.”
The goal is to make it easier for those people to do what they are trained to do, and for patients to get more out of every interaction they have with it.
