This study confirms what all physicians already know – health insurers place obstacle upon obstacle in order to avoid payment of claims. Prompt payment, which is mandated by laws in many states, is a pleasant fiction. The first reform needed is to make sure that all health insurers follow a similar form and submission process, this includes electronic filing and payment, which does exist with Medicare and some Medicaid programs. Second, insurers need to be prevented from issuing approvals for care, tests, treatments and surgeries, followed by the familiar refrain, approval does not equal a guarantee of coverage or payment. Approval should equal coverage and payment, period. Third, all health insurers need to be prevented from denying coverage for pre-existing conditions. They also need to be prevented from dropping subscribers once they become ill or injured. Lastly, drugs, tests, treatments and technologies that are approved by the FDA should be covered for payment, maximizing the choices patients may enjoy as they work with their physicians to deal with the condition they face. Medical directors at health insurers provide a smoke screen for companies who claim they are not dictating care, when in fact they are by their coverage and payment policies. Only through these reforms can we eliminate much of the needless, unnecessary, wasteful and costly insurance “dance” that providers must do in order to justly paid for legitimate services . . . obi jo and jomaxx
Studies seek to put “price tag” on physician practices’ costs to interact with health insurers.
Research suggests a physician may spend nearly three weeks a year on health plan-related tasks, two new Health Affairs reports attempt to put a price tag on how much a medical practice must spend before it can extract a check from an insurance company. In one study, University of California researchers calculated that the annual cost of performing billing-related tasks comes to about $85,276 per physician. In another study, Cornell Medical College researchers estimated that the total cost of the nation’s physician-health plan interactions is somewhere between $23 billion and $31 billion. The authors of the first study concluded that automation could be helpful in reducing claims denials, ensuring coding compliance and reducing days in accounts receivable, and that standardization of benefit plans ‘appears to offer great potential’ to decrease costs. The authors of the second study noted that their high-end estimate of physician-health plan interaction costs — $31 billion– is equal to six times the amount the federal government spends on SCHIP.
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What is the cost for the paper work needed to handle all the insurance forms that must be filled out by hospitals or doctors? How many people are employed to do this paper work?
How do these numbers compare with other countries health systems?
The costs quoted relate to the effort expended in filling out forms (paper or electronic), obtaining verifications of coverage, obtaining approvals for visits and procedures, etc. There is “paper work” involved in other health systems, but the main difference is the back and forth with insurance companies over coverage and payment. Simple rule making could deal with this. But Medicare and Medicaid also have somewhat onerous documentation requirements although they have implemented more useful electronic systems over the past decade.