Friday, August 7, 2009

This is efficiency?

For most of us, paying a bill is easy. I mean...unless we don't have the money, we look at the bill, we write the check, we send it in. Nowadays, we may do it online. If we have a problem with the bill, we'll call someone, maybe ask for an itemized statement, but that's about the extent of it.

But that ain't how it works in the healthcare industry, is it? I copied the following straight from Andrew Sullivan's The Daily Dish, because I thought it was a great view of the kind of efficiency we get by having private insurance companies handle health care instead of the big, bad G.

As Reino's favorite motivational-speaker, fitness instructor Susan Powter would say: STOP THE INSANITY!

I work for a national insurance company and it's my job to pay hospitals
and clinics for services performed. Now when I say pay, you should think of that
in air-quotes. Assume it takes a week for the bill to be routed to the right
person in the right department at my company. Once the bill reaches the right
desk it heads back out. Because before we pay a bill we send it to a 3rd party
company who reviews it to see how much we "really have to pay" for the services.
This is because every state has different guidelines about what services should
cost. This takes a week. Then the bill comes back to us, and if there are no
issues with the hospital's records in our systems we pay the bill then.

However, if there are any issues it comes to me.

It's my job to call the hospital for updated tax forms (because it's
not enough that we know their tax id, we have to have a government form showing
the number). Then I send the records to another company who updates our database
with the information. This takes another week, or longer if I have trouble
getting a hold of the right person at the hospital.

Finally, we pay the bill. During this time the hospital has been
waiting to get paid X number of dollars. Only instead we'll be paying them Y
because that's what the state says is the minimum we have to pay.

So while your readers are being charged $50 for asprin; my company
employs an entire department just to shuffle bills around while they decide what
they will pay the hospital for that asprin.

4 comments:

Mike Reino said...

There's no such thing as smooth medical billing - even if the ins. co. isn't involved.... I've spent the last 6 months trying to get either my doctor or the agency to confirm that I paid everything, and neither will call me back.

Cheesefrog said...

An anonymous health care worker claims that there's red tape in the current process, and that's an argument FOR the government (which OWNS the patent for red tape and inefficiency) taking over. Really?

Man, you'd better bring some of that primo stuff you're smoking when we hook up at the Dolphins game this season. We are gonna get SO wasted!

pluvlaw said...

Listen...if you ever want to stop a bill collector on medical treatments, tell them you'd like an itemized statement. I paid a bill for a surgery 3 years ago and then got another bill 6 months later. I argued that I had already paid. They said no. I said fine, send me an itemized statement showing all costs and all payments by my insurance company and by me. I'm still waiting. I occasionally get a call every 3 months or so. I ask if they see in the "notes" where I asked for my itemized statement. They say yes. I ask if they see where it has been sent. They say no. Then the phone call politely ends.

Danny, I posted that because of the argument everyone uses about how inefficient a government plan would be. If you think health insurance companies are efficient, I intend to smoke some of your primo, brother. My damn stepdad has a telephone conversation he taped where an agent of his insurance provider told him to cancel part B of Medicare, he did not need it. It was redundant. So he did. Then he had a whole bunch of bills and they turned them all down.

I handled it all the way through their administrative appeals procedure and then turned it over to another atty. It was a clusterfuck of 4 different "companies," the efficiency of which was to simply try to make it hard for people to pin any actual decision on somoeone.

Or the client I had who had to get turned down everytime he went to get his cholesterol meds. Then take that "denial" home and call the damn ins co. That went on every two weeks for a year (each time claiming, ok we got it fixed this time). He finally came to me, I sued. Lo and behold, the week before we go to Court, the problem is finally actually "solved."

The point is...if you're opposition is efficiency, then you should be just as pissed with the private health insurance companies.

Cheesefrog said...

If the gov't will give me legal medical weed then I will be all for it, otherwise I can't imagine anything will improve.

For what it's worth, my hip replacement went off without a hitch when it came to insurance and billing. Example of the norm or aberration, I don't know. I'm extremely happy with my coverage but that's just me.

Honestly I just can't imagine how anyone would want political slugs in charge of their health care. There's just nothing good that can come of it.