Posted by Bill Sandweg on 29 August 2011.
There was another item in the news today, as there is on so many days, about the ever-increasing cost of health care. I have written about some of the causes of this upward spiral: increasingly sophisticated and expensive treatments; our ability to keep alive those at both ends of the cycle of life who would have died only a few years ago; the fee-for-service model of paying doctors and hospitals; and the natural human tendency of healthcare providers to maximize their income. Add to this mix the nightmare claims process created by the health insurance industry.
One of the criticisms leveled against the health insurance industry is that its members often spend as much time trying to avoid paying claims as they actually spend paying them. Anyone who has had a major claim denied and has had to participate in an insurance company appeal process knows what I am talking about. But even when the insurers are trying to pay a claim, they take a big bite out of the day of your doctor and his or her staff.
Almost every health insurer requires data input from the doctor which is slightly different from that of the others. Each has its own language, its own rules for getting pre-authorization, and its own list of covered drugs. I recently underwent some surgery and worked with my surgeon’s staff member whose only job was to interact with the hospitals and health insurers. She spent a good bit of time calling the insurance company and getting the hospital, the surgery and the post-surgery care approved in advance. Multiply this by the thousands of surgeries performed every day in the United States and you see why it is a costly part of our healthcare bill. According to a study recently published in the journal Health Affairs, the average cost to every physician in the United States for interacting with health insurers to bill, follow up on claims, confirm the scope of plan coverages and the like is $82,795 per year. That is a whopping big number.
There is no magic bullet which will solve the problem of our ever escalating cost of health care. We need to recognize that there are many causes and that it will take a broad approach which addresses many factors to begin to make a difference. Increased standardization in the health insurance industry should clearly be a part of any such approach.