Health insurance - it's amazing they function

[disneysteve]

I've posted before about issues dealing with health insurance companies. I know right now it is popular to be complaining about the government but trust me, the problems with the system go far beyond the Affordable Care Act.

My biller just called Blue Cross to inquire about a patient's insurance coverage. She was told that the patient has a $750 deductible. She asked if the deductible had been met yet. You would think that would be a fairly straightforward question for the insurance company to answer. Instead, the person she was speaking to said he would need to add up her claims. She waited for a minute or so of silence and then asked what the deal was. He said he was adding up the numbers, not with a computer or a calculator, but manually writing them down and adding them by hand. That's why it was taking so long.

Blue Cross is one of the biggest insurers in the country and their claims reps are practically counting on their fingers to answer providers' questions. And we wonder why so many mistakes get made.

[soogar]

I think that health insurance is more "profitable" the more inefficient it is. I wouldn't be surprised if the government is counting on health insurance becoming a huge employer and somehow factoring in the economic recovery which is why they are receiving those subsidies.

[marvholly]

For me it is signing up for a Medicare Advantage plan. My current plan raised all co-pay inc Rx so I decided to check other plans.

Called the 800 number for 3 avail in my area >2 weeks ago. Got partial info from 1 plan. NOTHING from the other 2. If customer service cannot even get a mailing out how can I trust they will be responsive in ANY way?

Pulliung my hair out right now trying to decide what to do.

[disneysteve]

Another wonderful insurance company story (and this is not the first time this has happened to us):

We saw a patient on October 18. At the time of his visit, we verified his insurance coverage to be sure it was in effect and he was signed up with our office. We do this every day for every patient.

This week, we get a notice that his primary doctor was retroactively changed effective October 15 so the October 18 visit would no longer be paid because of that.

Just to be clear, a week AFTER his visit with us, they allowed him to change his doctor as of 3 days BEFORE he saw us. So the verification we did at his visit was meaningless. Essentially, there is no way for us to be sure that a visit will be covered if they can revoke coverage after the fact.

And they wonder why there is a doctor shortage.

[GREENBACK]

I have been fortunate to never have needed a major medical procedure in my life at age 48. I have, however been puzzled at how some relatively minor things like a root canal or two can create such confusion in the billing process (Long story). I can't imagine what it will be like when I really need major medical work.

[ua_guy]

Another wonderful insurance company story (and this is not the first time this has happened to us):

We saw a patient on October 18. At the time of his visit, we verified his insurance coverage to be sure it was in effect and he was signed up with our office. We do this every day for every patient.

This week, we get a notice that his primary doctor was retroactively changed effective October 15 so the October 18 visit would no longer be paid because of that.

Just to be clear, a week AFTER his visit with us, they allowed him to change his doctor as of 3 days BEFORE he saw us. So the verification we did at his visit was meaningless. Essentially, there is no way for us to be sure that a visit will be covered if they can revoke coverage after the fact.

And they wonder why there is a doctor shortage.

So the patient switched primary care providers retroactively, so his/her own visit wasn't covered by insurance? Not very smart.

Looks like your biller gets to transfer the charges to Self Pay and re-initiate billing...

[disneysteve]

So the patient switched primary care providers retroactively, so his/her own visit wasn't covered by insurance? Not very smart.

Looks like your biller gets to transfer the charges to Self Pay and re-initiate billing...

This is a Medicaid patient. We can bill them all we want but won't ever see a penny from them. It isn't worth the stamp to mail the bill.

[snafu]

I wonder of the paperwork on medicaid patient [example] change of primary care physician had not yet been processed when your biller called for verification. Perhaps patient was unable to get an immediate appointment with that Dr. so he landed in your waiting rm. Since some doctors don't take medicaid patients, is there a way for your biller to verify the primary care physician to avoid the loss to your business? Is there any point in re-billing giving name of agent who approved the original visit?

[RoadWorkAhead]

I carry duplicate insurance - free through the union and then pay for my employer plan (medically involved kid). The trouble I face is ridiculous. I go in with all my insurance cards every visit and say "Verify that you have both of our insurances on file." Yet monthly, I call because they billed only one or the other, or they bill secondary as primary or or or. The system breakdown is so huge, and there is so much waste in administration and billing. Yet they cut down on providers, nurses, etc. all the time Possibly the 18-32% administrative costs at most private insurance companies is part of the issue.

DS- I don't know how MDs/HCPs make it in private practice anymore. The overhead has got to be overwhelming with how frustrating we've made the payment system!

[ua_guy]

This is a Medicaid patient. We can bill them all we want but won't ever see a penny from them. It isn't worth the stamp to mail the bill.

In many cases, you're right, it's not even worth the postage or effort. But you do get to take a writeoff, right? That has to be worth at least something.

[JoeP]

Health insurance companies should be required to have an online tool that allows doctors' offices and the insured to see their benefits and balances at a glance.

Visit a doctor? You'll see a Pending charge against your total benefit (how much the ins company will kick in) and an actual charge against your deductible (how much you have to pay out of pocket). Add the 2 and you'll get the total bill cost.

This isn't rocket science. You could even have a little screen in the receptionist's window that you and the biller can look when a patient checks in, and then review after the appointment. Each party will know exactly what to expect as far as bills go.

Not much of a conspiracy theorist, but I honestly have to wonder if the current Confusion Coefficient exists by design so that "somebody" makes money from mistakes...

[hamchan]

I'm not surprised that they don't have user friendly features like this. There is no real competition. Most people in the US are insured through work, and few companies offer more than one insurer. So you are stuck with whatever you get there. And if you are paying for a private policy but have since developed health issues then it can be really expensive if not impossible to switch to a new provider. My dad dropped his coverage with Blue Cross Blue Shield after having to sue them over paying a claim for an emergency appendectomy, and because he already had a heart condition as well he found that switching to a new insurer was prohibitively expensive.