I work in patient admissions in a hospital.

[SheilaT]

I've only been there three months, but from the second day I was crazed by our unconscionably bad "health insurance" system.

I'm supposed to collect money -- I actually have a quota I'm supposed to meet every month. But the cost of procedures are an ever-moving target, and I have been given NO training in how to determine the cost of a procedure I'm supposed to be collecting money on.

I'm supposed to verify that the insurance card a patient presents me is actually valid, good, and in effect.

Here are a few trivial reforms that would ultimately save millions, even though they don't even begin to address the fact that too many Americans are uninsured or under-insured.
Standardize all the forms. No exceptions.
Have the costs of all procedures and tests published and open to all. Show just how much everyone pays, each individual insurance company, each person who has no insurance.
Here's a novel idea: why can't every insurance card have a swipe-able strip like credit and debit cards, which would immediately confirm if the insurance is in effect and what a co-pay or deductible actually is? Many insurance companies make that information almost impossible for me to find out. And some insurance cards don't even print the member's ID number on it.
There's no need to go through the fifteen-minute Q&A I have to do with each patient, painstakingly finding out such important things as their religion and whether or not they smoke.

It is so incredibly obvious to me that the savings that could be realized by even a few of these changes are enormous, but they are still a drop in the bucket.

WE NEED SINGLE PAYER AND WE NEED IT NOW.

[Laelth]

1. "WE NEED SINGLE PAYER AND WE NEED IT NOW."

I couldn't agree more.

:dem:

-Laelth

[dgibby]

2. Send this to Obama asap!

Excellent suggestions. This is the kind of stuff he needs if we're ever going to get costs under control.

[Deja Q]

20. He already knows it.

http://www.breitbart.tv/obama-in-03-id-like-to-see-a-single-payer-health-care-plan/

Either "change" is "slow" or "pretend". Two inferences out of many. Who knows. I'm only going to get back to life. There's no point in speculation. Unless there's profit in it.

[havocmom]

3. Call your reps and tell them what you just told us. You do it well!

Write LTTE and tell the people in your area. You make a very sane and reasonable argument.

All the maze of paperwork and not enough information costs money in the process but does not put that money toward actual health care. Multiply that by all the different insurance carriers and THEIR maze, then figure that times the different hospitals... it must be a staggering amount of time, headache, and money going to grind the process down.

[Faryn Balyncd]

4. What other industry lacks pricing TRANSPARENCY and considers DISCRIMATORY PRICING legal & just?

(K & R, by the way)

Thanks for posting.

[Paper Roses]

5. Your comments are well made. It occurred to me as I read them

that the paperwork involved in my husbands emergency hospital admission for stroke, took away the final moments to be with him. He died during the time I was spending doing the admission stuff. It could have been done later but rules are rules I guess. I lost those 20 or 30 minutes with him, he lost the battle. The outcome would have probably been the same but maybe I would have been there for a minute to say I love you one last time.

It took no time for me to get the emergency room bills. Medicare covered some but not all of the costs.

[barbtries]

24. i'm so sorry for your loss

it should have been different.

[postulater]

6. Add to that, every insurance company has different levels

of coverage. Different deductibles, different copays, etc.

And every insurance company that the clinic/doctor is contracted with has different allowed (and, of course, severely reduced) fees.

Sometimes the insurance company can't even tell the doctor/clinic what plan the patient has or if the clinic/doctor is in the network.

Because of that, there is no way to tell what fees or benefits the patient qualifies for.

Then there is no way to know who pays what and the doctor/clinic may spend hours on the phone trying to sort it out.

Of course if the insurance company screws up, it is the doctor's/clinic's fault and they get all the blame from the patient.

So beside getting a reduction in their fee of around 30%, and beside spending huge amounts of time trying to help the patient get the contracted benefit from their insurance company, the clinic has to deal with the patient who is getting screwed by an insurance company that they thought was "the best insurance around."

And it is all the doctor's/clinic's fault. :sarcasm:

[liberalhistorian]

7. Umm, I'm sorry, but I have yet to encounter a doctor/clinic

that will spend any kind of substantial time on the phone with insurance companies, let alone "hours." Most of the time, it's made very clear that they only bill insurance as "a convenience to the patient" and it is the "patient's responsibility" to ensure insurance and straighten things out. And try finding a doctor/clinic that will even see anyone who's uninsured or who doesn't have a ton of money upfront, it's almost impossible. I know, 'cause I'm currently uninsured.

[postulater]

11. Umm, I'm sorry for you too.

I just explained how we do things at my office. Sorry you can't find an office to go to bat for you.

[barbtries]

25. for the record

my doctor's office admin has spent 20 minutes in one day just on one phone call for me personally. they do it all the time.

[SheilaT]

18. Bingo!

We are pressured to collect co-pays and deductibles, and it is nearly impossible to figure out what they will be.

I was already in favor of universal health care, and I'm so much more so now.

Also, I have the "death panel" discussion with nearly every single one of my patients when I give them information about Advance Directives, and point out how very important it is to have something in writing that expresses their wishes.

[csziggy]

22. I'm convinced that the whole system is designed to make it easier to deny claims

Because no one, patient, doctor, clerks who administer the claims, no one knows exactly what a specific policy is supposed to cover. There is no incentive for the insurance industry to make it easier to navigate since that would make it easier for everyone else to figure out how often they capriciously deny claims.

My now retired doctor (who I loved dearly) had a one doctor practice with a nurse practioner and three regular nurses. To support the medical staff, he had a receptionist and file clerk and five or six insurance clerks. Each insurance clerk specialized in a different company so they were familiar with that company's forms and procedures. Maybe some of those clerks worked part time, but they sure seemed to be busy every time I was in the office!

My doctor did not retire because of his age - he retired since he was spending far too much of his time and the money paid for treatment to deal with insurance claims. He now works part time at an HMO so he does not have to deal with insurance claims at all.

We need single payer now. I hope we get it before I die.

[dixiegrrrrl]

8. So you are saying that procedures have no fixed rate

and the prices change willy nilly?

[postulater]

13. Absolutely.

If the clinic has a contract to be in the insurance company's network, then there is a fee schedule that is set by the insurance company.

Every contract has a different fee schedule. So a clinic could have hundreds of different fees for the same service, each set by an individual insurance company contract.

Sometimes the clinic can't tell if they are in the network or not. And the insurance company often can't tell them either. Then there is no way of knowing what the fee schedule will be.

Even worse sometimes the insurance company, even though the clinic is not contracted with them, will search around and find a totally separate company that the clinic IS contracted with and then purchase access to that company's contract in order to reduce the clinic's fees. This is called a 'wrap-around' contract and effectively reduces the clinic's fees without the clinic's agreement.

[SheilaT]

19. Basically, yes.

Because each insurance companies negotiate separately with the hospitals and doctors about what they'll pay for various procedures, there's no fixed rate. Plus, I check in patients for things like ultrasounds and MRI's, and since the orders are often written in a way that do not match all of the many, many different kinds of ultrasounds and MRI's that can be done, often a price quoted is said to be merely an estimate, and you won't know what the true charge is until the final bill comes in.

We are also authorized to offer in immediate 30% discount off the stated price if the patient can pay the full amount immediately. But often I have no access to any kind of an estimate as to what the procedure will cost. I really need to confront my bosses about that, but we're also in the process of getting trained for a new computer system that is supposed to go live November 2nd, and I don't have any idea if this pricing crap will change.

Oh, and there are several lists available, depending on which computer I'm on in the office, and one gives a list of prices week by week with fairly recent prices, another one gives prices as of some date in 2006.

I think the next time the head of my department comes in and talks about collecting money, I'll point out that I need clear and accurate information about what to collect, and stop fretting that they'll let me go.

[uncle ray]

23. their offering to settle for a huge discount is telling to me.

i'm currently dealing with paying for a very simple procedure on my girlfriend, just a few stitches. ten stitches were $1075 total. of course they had no idea what to charge us even if we wanted to pay right at the time of service, and i could see the list of what was performed right there on a computer screen in front of me. but they did make clear right away that they offer a 40% discount if payed within 40 days. that yelled out to me that there is a huge amount of very easy savings to be had by going to a true single payer system, or even taking the worry of nonpayment out of the current system. you could eliminate a lot of billing and collection expense. i'm sure many of the people working those jobs would love to transition into actually helping to care for patients rather than their current positions.

[Kansas Wyatt]

9. How does a company (insurance, pharma, medical) make it possible to defraud others?

You create a system that is so complicated that nobody can figure it out without spending a lot of time (10 times more than is reasonable) on it.

There is a specific reason why companies create long complicated rules, contracts, forms, etc. etc. They are designed to screw the consumer. It is also the same reason that our alleged representatives have created a tax code that stands a foot tall and credit card companies have pages of fine print.

[Mudoria]

10. I wonder how fast the health care system would crash

if fixing a broken arm in Wherisit, Maine cost exactly the same as Whatchamacallit, California?


Why can't there be some reasonable fixed rate for a procedure coast to coast?

[Gormy Cuss]

15. There are good reasons to have regional differences in the reimbursement rate

since costs and salaries are different based on local area economic conditions.

There is no excuse however for Ms. Pelkey's broken arm to cost more than Mr. Searway's when both were fixed in Whereisit, ME.

[bigwillq]

12. K and R.

:thumbsup:

[surrealAmerican]

14. Those are all good suggestions.

I would like to see them implemented regardless of the other aspects of the reformed plan.

[Vidar]

16. K&R

[Posteritatis]

17. re: stuff like the forms..

I wonder how many sagans of dollars a year would be saved simply because of standardizing basic paperwork like that? Even leaving any other reforms or changes or laws aside, simplifying some of that stuff would probably add up bigtime.

[SheilaT]

21. Millions, if not sagans.

Essentially I should not have the job I do. There's no need for most of what I do. If we had the right kind of universal health care that other civilized countries have, all that would be needed would be a receptionist of some kind to make sure the patients make it to the right department, and some kind of minimal id-checking to make sure the patient gets the procedure or test actually scheduled for that person.

Every single person with a Medicare card also has to answer a Medicare questionnaire, every single time. First question is, Are you receiving Black Lung benefits? That one generally makes people stare at me as if I've suddenly started speaking some foreign language. Next question is, Are you here as part of a government research project? WTF? Even I have no clue what that actually refers to.

The idiocy is that this questionnaire comes up every single time, that the answers are not preserved with the Medicare account that goes with that person.