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Ye Olde GasPasser Sez:
 
DOUBLE (BLUE) CROSSED

    It's become a bad joke, American health insurance, and it can't continue like this much longer.  Not without a revolt.  Maybe this afternoon.

    The irony hits me, you see, only after I've been on hold for hours, twiddling my thumbs, phone to my ear as I wait my turn to beg and plead, to cajole yet another clerk -- bored, anonymous, and unsympathetic -- at this giant health insurance corporation.  I'm trying once again to extract payment for an anesthetic I gave a young patient almost a year ago.  A year!  And then I realize -- I am such a sucker, duped both coming and going, because this insurance company ... it's my own, the one to which I pay my own premiums myself.   So I'm doubly double-crossed.

    The realization stings: this mega-corporation supposedly somewhere on the other end of the phone line not only treats me like dirt when I buy my coverage as a consumer, it also cheats me as a provider after I supply anesthesia care to their beneficiaries.  Every quarter they hike my premiums higher and yet higher, all out of proportion to the risk I present (jogger, vitamin nut) -- and certainly they demand my checks on time; yet here I am, twiddling my thumbs for a week or three this long afternoon, forced to fiddle away the hours in order to pry loose my paltry fee from their grip.  Ouch.  Double ouch.

    A recent AMA study shows that certain health insurers are consistently more than 120 days late in paying 'clean' claims; the ones, that is, which the insurance companies do not reject for some picayune defect.  One physician's office I work with has a consistent 25% rejection rate for initial claims.  Claims must then be re-filed and bird-dogged ad infinitum.  More people in health care chase paperwork minutiae than deal with patients.  It's more paper-care than patient care!  Sad wasteful state of affairs.  Americans in general get less bang for their health care buck than inhabitants of any other developed nation on earth.

    This insurance dodge is a two step dance: they first Deny Payment.  Then, when they can no longer deny payment, they Delay Payment.  They've invented uncounted obstructionist tricks, such as 'Precertification of treatment is no guarantee of payment.'  Why then bother to precertify at all?  It's wasteful. 'Just business,' they say.   Well, like Enron, such businesses cannot last.  What goes around comes around.

    Most healthcare providers I know -- physicians and nurses, CRNAs, nurse practitioners -- we approach health care not as just a business, but as a profession, a calling.  I endeavour to treat every patient I put to sleep with the same degree of care as if they were a member of my own family.  Whereas insurance companies often treat clinicians like The Enemy, like pigeons to be fleeced (to mix my metafurs).  Long term, this adversarial foot-dragging and head-butting will not only damage doctors' and nurses' collectively idealistic motivation and our financial well-being, but it will eventually boomerang and impact the insurers themselves -- their financial health -- and, as these companies collapse, the pocketbooks of the public at large -- you, whose premium dollars are currently going to waste, by the bushel basketful.

    This is not my first time twiddling my thumbs on hold trying to settle a claim for my services as a nurse anesthetist.  I'd much rather be out on my bicycle this sunny afternoon.  Anywhere else.  In my practice I do only a small volume of private insurance, so I don't utilize staff to handle these billing duties; therefore, I see firsthand what most providers do not -- the grief that office staff must endure, the stultifying hours wasted all across America, hours spent on hold every working day.  Uncounted wasted hours, and millions in wages paid, in sum total contributing zero value to patient care.

    Why?  Because insurance companies want me to capitulate, to give up the on-hold waiting game and go jump on my bike -- to not pursue my rightful claim to payment.  It happens all the time.  Most doctors and other providers don't appreciate just how often their billing clerks do in fact say, "Sheesh -- it ain't worth the hassle!" and throw up their hands in frustration.  That claim gets sidetracked, dumped, filed as uncollectable.  Then the insurance companies get to keep the money.  That's why they continue to erect these ridiculous hurdles, one after another.  They are emphatically NOT in the business of paying me; there's far more profit to be had by NOT paying me.  Deny payment, delay payment, add more hurdles to payment.

    Other AMA surveys now show some physicians' average claims to be more than 100 days overdue.  Can you pay your bills 2-4 months late?  I can't.  Prompt payments laws that do exist in various States are widely ignored.  Some physician practices experience average payment delays of nearly one year.  A year!  Certain practices are owed more than $2 million in late payments -- in certain instances, in excess of $1 million by one single health insurance company.  That's absolutely nuts.  This can't go on.

    What'll happen?  If insurance won't pay, then some day your family doctor and all us other providers nationwide will no longer accept insurance.  No more promises.  Cash please.  That's how we all pay our bills.

    Dr George Lundgren, former editor of JAMA, recently suggested that American health care went seriously wrong back in the 'Fifties when third-party payers, health insurance corporations, became the principal way to finance medical care.  That created a disconnect between the source of the health care dollar -- you -- and what it is spent on, taking you the consumer out of the loop.  Do you get what you pay for?  Our single biggest problem in health care today is inefficiency, Dr Lundberg points out.  In his book SEVERED TRUST: Why American Medicine Hasn't Been Fixed, he proposes a three-tiered structure to salvage health care, and the Doctor may truly have found the key: everyone would get basic preventative care, plus catastrophic care coverage for all, and the rest of our services we would finance out of pocket ourselves.  Cheaper in the long run.  Monumental waste could be eliminated; as high as 25-30% of each health care dollar now spent is wasted.  And, as Dr Lundberg points out, with his proposed system there also would not be any uninsured population in America.  And more smiling providers.

    Meantime I'm still here, on hold.  Nice weather outside.  Heard any good jokes lately?

----WJ


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