Monday, March 22, 2010

thoughts on healthcare from someone who works in the industry

A lot of my friend's blogs have had posts on the newly passed healthcare reform bill, and while I don't pretend to be someone who is knowledgeable about, or even very interested in, politics I just wanted to throw in a few thoughts.  I'm not making a political statement and am not well informed enough to make judgments on this bill, but as a person who works directly with insurance companies in the healthcare industry, and having chronic health conditions these are the things I know for sure:
  • The system as it has been does not work.  I spent this morning sending accounts to collections and having to discharge patients from our practice for not paying their bills--very often because the patients are uninsured or underinsured. It is not fun to tell a family that they can no longer see their pediatrician because they have not paid their bills.  I waver between being very jaded and callous about the situation to being absolutely broken hearted at this part of my job. 
  • The people who are suffering under the current system are often the middle class--there are state programs to support low income families, many providers offer discounts for the uninsured, and most wealthy families have access to good coverage through large companies. Then there are the middle class families--many are paying out of control premiums to have coverage at all, but their plans require deductibles and coinsurances which still cause the patients to pay most services out of pocket. However, since they "have insurance" no additional discounts are generally given. (this is a generalization, I know, but it is what I see daily)
  • I have watched insurance companies go back to charges filed a year ago and recoup payment stating that they paid in error--most of the time b/c patients did not update other insurance information (which is only requested once a claim is filed) or because they made a retroactive preexisting review and decided that a condition was not reported and therefore the patient should not have been covered at all.  Then the patients are stuck with hundreds of dollars worth of bills that they thought were covered.  
  • At 25, I have been denied insurance coverage for my health conditions.  The one plan that would accept me had a $1200 per MONTH premium.  Thankfully I have coverage through my husband's work (at over $300 a month just for me, and that is with his employer paying part of my premium), but if we lose that coverage I am in big trouble, because my office (despite being a doctor's office) does not offer insurance to employees, and without a group plan I am basically uninsurable. 
  • Many of the families who do have insurance are completely ignorant of their policies.  Whether this is user error or failure of HR departments, employers, or agents to explain the terminology, I don't know, but it is awful.  They don't know that their insurance applies vaccinations and preventative care to a deductible...and then they get a several hundred dollar bill that they are stuck with.
  • Communication from insurance companies and the many requirements to keep a policy active and up to date are very confusing, and generally only come up when there is a claim filed.  75% of the denials I deal with are for Coordination of benefits: the insurance wants to know whether or not the patient has any other active coverage.  This is an extremely routine thing that most companies require every 6-9 months, but the patients don't understand it.  Then they don't fill out the paperwork or call the insurance company.  Then all their claims are denied.  I do my best to educate our patients on this with letters and phone calls, but there is only so much that the provider can do b/c only the subscriber can update this information (don't even get me started on what happens in situations of divorce when one parent gets the bills but the other holds the insurance!).
Like I said, I do not know enough about this plan to really make a judgment on whether or not I think it will work, and I honestly don't have any great suggestions, but what we have now is not working.  I see the nasty side of things every single day at my job, and it is so hard when you are dealing with children who NEED these services but their parents can't afford to pay.

1 comment:

  1. insurance companies are one of the only things in the whole world i truly despise... i am totally feeling you.