Wednesday, August 12, 2009

This is why Health Care needs to be reformed, somehow

Andrew Sullivan's blog is again pointing out some of the awful absurdities in the current health care system, pain points that are being blocked out by the current "debate".

For instance, a reader writes in:
For a few months, I worked at an electronic medical billing company. I was astounded at how complicated and convoluted medical billing is, and this is ultimately why we need to have significant health insurance reform. What happens is a doctor's office will decide on a price for a procedure - for instance, a checkup typically costs around $180. Say I have Tufts. They might pay out $100 for a checkup - the rest the doctor writes off. Why not just charge $100 and not have to write off $80? Well, that's because other insurance companies - say Blue Cross and AETNA - might pay $120 and $150 respectively. So it make sense for doctors to charge significantly more than they would expect from most insurance companies. However, if somebody doesn't have good insurance or has no insurance, they are billed for the full amount -$180, even though the doctors office might expect to write off up to $80 dollars of that charge from somebody with good insurance. Given that the majority of the people without health insurance are lower income, this can cause crippling financial problems, or result in a denial of service. And why? Is someone with insurance "better" than somebody without? Are they more deserving of good health because they happened to not get laid off during a particular bad recession?


And another of his readers - who worked a job where they tried to automate medical procedure approval processes - points out the amazing waste that takes place in every doctor's office or hospital in the amazingly antiquated approval procedures that take place manually every day. Details after the link, but then there's this:
Of course we know that just because the insurance company says they will pay, it doesn't mean they really will. There's a whole different team of people who have to pick it up on the back end in that case.

Everyone who thinks that their current insurance is good, hold your breath that you don't get sick, because you never know what you will or won't be charged once the procedure is completed.

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