(If you have never read “Breakfast Smoothies” you might want to read the short introductory page. Explanations about the most blatant lies usually follow the essay.)
If we had a system efficient enough to deny health care to us before we go then nobody would be happy.
The insurance companies want both the patients and the providers to believe they will pay. Then tie us all up in paperwork while not paying. This makes it look as if the insurance companies are doing something and we, the patients, are the problem.
When I served our breakfast smoothies, Don and Tim were looking over Tim’s collection of paperwork that he brought with him this morning.
Tim had gone to the doctors for a regular appointment and then for blood work and an x-ray. He asked Don to join us for smoothies because Don had owned a CPA firm before he retired.
Don shook his head. “Just because I ran my own firm does not mean that I’m qualified to explain this mess. These people have taken invoices to an entirely new level of convolution.”
Tim said, “I’ve tried to make sense out of these pieces of paper. Here are the bills for the original visits: the doctor, the lab where I had blood work, and the radiology office. Most of them say they’ve billed my insurance and I don’t need to pay any more right now. I already paid the office visit fee at the office. Except I did not have to pay an office visit for the lab. Why is that?”
“Then there is the EOB from the insurance company. That’s called an Explanation of Benefits despite the fact that it does not explain anything.”
“Right. I think I’ve matched them up to the three visits. Here is what I can figure out.”
“The insurance company is not going to pay for the lab because I have not met my deductible. They will pay for the doctor’s visit; for some reason, I’ve met my deductible there. They are not paying for the radiology visit because they need more information about something.”
“And then I’ve got other papers, where the doctor’s office says I still owe something, and the radiology office says I owe the entire amount because it was not authorized for that diagnosis, or some other information. I don’t have anything from the lab yet. Is that good?”
Don looked at me. “I think they’re trying to engulf him with paper.”
Tim looked at us both, “What do I owe? What do I pay? I already paid the insurance company and I already paid something at the offices. What is this?” he was looking at the smoothie.
This is the “Green Hornet” smoothie. It’s a kale smoothie. It should make you healthy.
“I meant the paperwork,” said Tim.
I know, I said sadly. The insurance company and each of the offices you went to have negotiated until they think they can make some money from each other and from you. The government has passed laws to prevent them from cheating you. All together, they have made a mess of paying for and providing health care in this country.
When we buy gas at the pump with a credit card, all parties to the transaction want us to be happy. They all want the transaction to be successful and easy. We get gas and can drive home without having cash on hand. The petroleum industry gets money for providing the gas. The bank makes money by providing the facility to pay and for extending the credit. The credit card company makes money by billing the transaction. If any of it does not work smoothly, the system falls apart and we don’t do it next time.
When we show up and provide our insurance card at the health care facility nobody has incentive for the transaction to work. The insurance company makes money by not paying for the service.
Billing of the transaction is also fraught with negatives. An inordinate amount of time is spent in re-billing claims rejected by the insurance company. The entire billing system is based on not providing the best service and not paying for it.
When I’ve put together computer systems in hospitals in other countries, they don’t have a billing component to them. The computers keep track of your health record, not the amount you owe. And there are no insurance companies to take your money and nobody for the hospital to bill.
“Don’t they have super high taxes; and don’t they have to wait forever for an appointment?” asked Don.
Yes. And how much are your insurance premiums, how much is your employer paying, how much do they still want you to pay, and how long did it take to get your appointment, Tim.
“Too much. Too much, too much, and too long,” said Tim.
“And how do you feel,” said Don.
“You’re the only one who has asked.”