John Deering for October 08, 2009

Their experience doesn’t come near the reality of a government claim. Minimum staffing requirements, featherbedding, employ a million dues-paying straphangers, each of whose assignment is to verify one block of each claim form.

Based on what, ANandy? This is reality NOW.

My brother’s a doctor and is drowning under private insurance paperwork – because it’s not just one type of form but a different set of paperwork for each company. They aren’t doing doctors any favors, I assure you.

Once again Anandy misrepresents the streamlined Medicare forms. Claims are paid faster than private carriers. Oh, why bother?!. Ignorance is bliss! [But very expensive!!]

DOCTORS DROWN UNDER ALL INSURANCE FORMS INCLUDING MEDICARE……I PREDICT YOU’LL BEGIN TO HEAR FROM THE PROFESSION AND NOT THROUGH THE AMA

Puiblic healthcare doesn’t mean more paperwork. I live in Canada and in my 25 year-life, I remember one time where I had to fill papers;I had to sign two things after I got in the hospital for a bad case of depression. I also remember when my dad left the hospital once. He had a relatively small risk of doing a stroke but being not too fond of hospitals, he insisted on leaving anyway so he had to sign a disclamer saying he wouldn’t sue the hospital if anything happened.)

I’ve been to a number of doctors since the beginning of August. The insurance claims have all been done by computer. I haven’t filled out any claim forms.

charlie, why don’t you ask the insurance companies?

charlie, the old days of a patient paying for a medical service and then submitting a claim to insurance co. for partial reimbursement are long gone, though there may be a few traditional 80/20 policies out there. Now, the medical provider must submit claims to substantiate that whatever service/treatment was provided was medically necessary according to the protocols of the insurance co. which retains ultimate right to determine whether service was needed and what portion they shall compensate. The patient is then responsible for remainder according to the details of that particular policy.

is it a fair guess to suggest you haven’t had employer-sponsored healthcare insurance in a while or you’d know this?

charlie, the reason why physicians (their staffs) prepare claims is because the checks go to the physician these days, not the patient. Physicians have to prove every service they provide was medically necessary, not just that they actually provided it. Only some things require pre-authorization, thus physicians have to substantiate every claim they make or the insurer will deny it.

The consumer still is involved, though they have no control over amounts negotiated between insurer and doctor or other medical facility.

My last private insurance is a good case in point. it was horrendous. it had a relatively high deductible, $1,500. It was a PPO so I made sure all physicians and facilities I used were on the PPO list. I had an outpatient treatment that was about $2,700 between the hospital, doctors, etc. The insurance co. managed to claim it owed only $170 and the rest was my cost. BTW, the monthly premium was $320/mo.

They accomplished this by disallowing the claims for the pathologist and lab work, saying these two were not on the PPO list even though the hospital was and the lab and pathologist are hospital-based.

They also came up with a “co-insurance” payment as well as a “co-pay,” which turned out to be nothing more than doubling the co-pay without having to state the correct co-pay figure in the policy. If the co-pay was $100, the co-insurance was $100. Therefore, the true patient co-pay was $200.

This is why we’re in the mess we’re in and even with health insurance, some folks go into bankruptcy.

It won’t be any harder than understanding our tax laws.

Another problem-doctors and other health care professionals I know tell me the rate of reimbursement for them is lower in smaller, more rural states like my own than in other areas. No one has been able to explain this disparity, and it’s not because of a difference in cost of procedures in different areas.

Regarding the future of health care, my own physician thinks that we’ll either wind up with a continuation of the status quo, or, if some compromise is reached, it will be a half-measure that no one is really satisfied with.

This is a pessimistic appraisal coming from someone I respect.

bueller, I share your physician’s pessimism. It’s been clear from the start there would not be a bipartisan approach to reform when many on right think the #1 goal is to enact tort reform on medical malpractice claims and many on left want a single payor. Some advocate a major overhaul of the delivery system (not medical care) and some want to tinker around the edges.

Know what it reminds me of? As late as August of 2008, some national leaders were still saying the fundamentals of our economy were strong and vibrant. Then in Sept. it blew up. It strikes me we’re about in the same place.

As far as Medicare reimbursement schedules, there’s been too much politics injected into the system … surprise, surprise. Powerful members of Congress get their areas and districts moved into higher reimbursement levels, while some high-cost-of-living areas are still considered rural and thus have lower reimbursements.

The House bill sets up a new mechanism for determining the rate schedules for Medicare which distances it from the direct influence of powerful congressional members. Who knows how that will end up, the GOP is very critical of the new mechanism and want congressional control over rates schedules to continue.

More and more I think I favor single payor and just eliminate the inefficiency of layers and layers of middlemen all taking a big chunk for profit.

bcs, from the start, I thought this whole effort was misnamed. Would it not be more to the point to call it insurance reform?

I think you shed some light for me on the inconsistancies of the reimbursement process, or rather, the reasons for them.

Bueller, yes, I think it is more accurate to refer to it as health insurance reform …. and I hope some reform of abusive practices actually occurs!

In the world of insurance companies this is just another work day.