The insurance companies want both the patients and the providers to believe they will pay. Then they 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. Or we think those nasty providers are the problem.
I had visited the doctor for a regular appointment. He sent me for blood work and an x-ray.
I have bills for the original visits: the doctor, the lab, 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.
Then I have the EOB from the insurance company. That’s called an Explanation of Benefits despite the fact that it does not explain anything.
I think I’ve matched them up to the three visits.
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. But they will not pay the full amount. There is a contractual adjustment they are not going to pay, then there is what I owe: co-pay, not covered services, whatever. They are not paying anything for the radiology visit because they need more information about something.
I have other invoices. The doctor’s office says I still owe something, and the radiology office says I owe the entire amount because payment was not authorized for that diagnosis. I don’t have anything from the lab yet.
What do I owe? What do I pay? I already paid the insurance company and I already paid something at the office.
The System Does Not Work
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 and each of the offices you visit have negotiated to pay and receive less than the normal charge; less than what you would pay if you were paying yourself. The insurance company contractually agrees not to pay the full amount.
Then the office spends an inordinate amount of time and effort in billing the insurance company and then re-billing rejected claims. Since the government is protecting us from the insurance company’s predatory practices (and the provider’s predatory practices) entire departments are dedicated to coding and recoding diagnosis and treatment and then billing and re-billing the insurance company.
Nobody has incentive for the system to work. The insurance companies make money on not paying the full amount, not paying at all, or paying after delaying tactics. The providers have agreed with the insurance companies to take less money in the (probably correct) belief that they could not get this much money from their patients. The patients feel powerless (bankruptcy courts would agree). The billing and coding departments are happy to have jobs. The physician has no idea what he is charging. The facility administration has no clue what is going on and don’t want to think about it.
Health care offices in other countries, don’t have a billing component. They keep track of your health, not the amount you owe. And there are no insurance companies to take your money and no third party for the hospital to bill.
Do they have super high taxes?
And how much are your taxes, your insurance premiums, your deductibles, your co-pays? How much is your employer paying? How much does everyone still want you to pay?