|
|
08/16/2009, 07:26 PM
#1258
 Originally Posted by davidra
I'll tell you where misinformation comes from....people that don't know what they're talking about. I am a doctor. My office has to hire multiple people just to deal with multiple insurance companies. Each company has different things that they cover; in my case, they even require the patients to go to different laboratories, some of which are miles out of their way. It requires my employees to spend much of their time sorting through all the differences and making sure patients end up where they belong. So that's what is meant by what was said. Do you want to debate whether that makes sense or not?
The companies themselves have to hire large numbers of employees to screen all the submissions so they can determine which to deny, which to delay, and which to approve. While the approval rate is reasonably high, the manpower required is significant. It is estimated that most health plans have between 17 and 25% administrative costs, compared to Medicare which is likely somewhere in single digits. That is money that doesn't go to the doctor, doesn't go to the shareholders of the company if it's for profit...so it's money that doesn't go to care.
And this is the private medicine and insurance companies that everyone seems to think is so precious that we should just let them go on continuing to deny treatments and refusing to provide insurance coverage for people who actually own their insurance. While Medicare is no bed of roses, it's actually easier to deal with Medicare than with most private companies.
I heard the president-elect of the AMA speak the other night and spoke to him afterwards. While they do not favor a "public option", they strongly favor health care reform and they have planned suggestions for how a public option should be designed. He feels that in states that have offered public options, most people don't choose them, so he thinks much of the arguments for and against public options are ridiculous. Regardless, I am sick and tired of having to argue with for-profit companies about providing care for patients who have paid their premiums and then try and deny care by delaying tactics. My hospital sued one HMO for delayed payment two years ago and now they are filing againt BCBS for non-payment.
Anybody that thinks private insurance is the way to great care for all is smoking something...
Well....I do respect your view from the doctor's side and the hastle of dealing with multiple insurance companies, but let's face it, many issues arise from the doctor's office as well.
Now, some are related to physicians being concerned with missing a test and then later getting sued over not ordering a test....and I can respect that point of view. Just recently my primary care doctor wanted me to go for an expensive Thallium Stress Test ($2100 +) when a trip to the cardiologist showed I didn't need it ($350 for that visit rather than $2100). My physician had no idea the test would cost that much (at least that is what she said). Had I not asked about some options I would have gone the more expensive route (I told the cardiologist that if I needed the Thallium test I would go in for it, but if I didn't, would prefer not spending $2100). Secondly, when I was first put on HBP medication, she originally put me on a 3 week trial medication that seemed to work just fine. It was a new medication and when I asked the price, she said it would be about $85 per month. I asked if there was another generic and she said, "sure", and I now pay $5.60 for a low dose of Lisinopril....but only because I asked about my options. Third....a couple of years ago I went in for my annual physical and they filed it with a diagnostic code rather than preventative code, and so it was processed as diagnostic and went to my deductible rather than paying it as 100% (I have an HSA plan which covers annual physicals at 100% and no deductible while diagnostic visits are applied to my deductible and therefore I must pay from my pocket). The insurance processed it exactly as it was sent to them, but it was the doctor's office that screwed up (same thing just happened to my wife as well) and I never could get them (the doctor's office) to process it correctly. I finally told them it was their mistake and I wasn't going to pay them, and they finally ate it. Go figure, not sure why they wouldn't just resubmit the claim as preventative.
So, while there may be issues with the insurance company, I'd just like to point out that the physicians also cause problems. I have dealth with many claims for my clients and it is amazing how many errors started at the doctor's office. Do insurance companies make mistakes? Sure they do....but they can only process what is sent to them. Garbage in, garbage out. I won't even get into the case with my client who went in for a pacemaker, had an infection afterwards, and after 2 more operations they discovered a sponge was left inside him from the initial surgery.
I guess my point is many areas can be made more efficient without throwing out the good part of our health care simply because some areas need to be fixed. While I do get calls to help clients with claim issues, I also know way more go through with no problems and they are quite happy with the results. But, these fixes can be done, in my opinion, without a public option which will eventually lead to single payer plans such as in the UK and Canada.
Oh....almost forgot....not smoking anything! Never have, never will!
|
|
|
But good try! 
