I too know of doctors that are dropping participation, but they are dropping all insurance because their costs of insurance billing administration are too high and the amount of reimbursement for the medical procedure does not cover the medical and the full time billing clerk. Those doctors will provide you the complete itemized bill but you have to file the forms and get reimbursed. Just the insurance billing expenses on the medical provider side are amazing. Here is a hunk cut from something I sent to a local Congresswoman:
First some background. I have been in the position of being a stockholder officer in a small business where we had to pay for health insurance to keep our skilled workers. I now work for a large company that pays for my health insurance administration and pays the health benefits out-of-pocket. For the past 30 years I have worked with clients in several countries (US, Canada, Mexico, and UK) as a business consultant, not directly with their health benefits, but seeing the effect of those expenses on their business. I see health care reform as critical to helping American business at all levels become more competitive with companies in other countries and to help control their long term cost as we come out of this recession. Small businesses that can not afford health insurance still have other higher expenses, because employees that get sick or have family members that are sick are like the walking wounded; a lot less productive than employees that are well and have the confidence that they and their families will be cared for. And if the employees are terminated, then you have the higher costs of time and money to hire and train someone else. Unlike what the popular press seems to think, employees are not interchangeable. I think the costs of the uninsured are underestimated because I doubt if those estimates include the cost of the walking sick who are less productive at work but not yet sick enough to go to the emergency room, and I doubt if those estimates include the cost to commun ities of those hospitals that have gone broke and closed or at least closed their emergency rooms because they could not get enough reimbursement for the unfunded mandate to treat everyone who comes through the door. I have always tried to get my clients to look at the total cost of what they do. As an employer, I would not care if I if I paid the money to the government or to a private insurance company, what I am concerned with is the total cost for equivalent benefits. As an employee I realize that every dollar that my employer pays for my health care is a dollar that he can not pay me, or can not use to make our company more competitive, so I do not care if the money goes through Social Security or through a private insurance company. >From the Total-Cost view, the major difference between Social Security >Medicare and private insurers is that Medicare has lower administrative costs >than private insurers. Yes, it has fewer options than private insurance, but >that is a major reason it has lower administrative costs both on the Medicare >side and the provider side. I once had a discussion with a person responsible for maintaining the computer systems for a large private health insurer. She made the comment that that insurer was very proud of the fact that they would setup any custom health insurance policy their customer (companies covering their employees) wanted; no matter how flexible or unique they (the employer) wanted the policy. Of course that generated revenue for the company making all the software changes required to support the claims processing. It was not part of our discussion, but I would bet that the cost for both the insurance company and the providers was also higher because of the necessary insurer review by people unfamiliar with all those different plans and providers with only a few patients on any one plan. I will also bet that user dissatisfaction was higher because of the higher volume of mistakes in claim review. Do not assume that people are in love with the insurance companies that administer their plans. They may like their coverage, but very few like the insurance company. If they have had any direct contact with them, they probably do not like them. In my own case when I have had an argument with the insurance companies administrating my company's health plan, I won, but it still left bad feelings towards those companies. And those companies did not have a direct benefit to denying those claims because the costs were passed through directly to my employer. I can only image the effort those companies would go through to deny benefits if it was coming out of their pockets. Health insurance today is not like other insurance. Insurance is supposed to be based solely on actuarial risk and the estimated cost of those risks. Health insurance companies may base their premiums on costs of those risks, but unlike other forms of insurance, health insurance companies can gain profit by gaming the legal system. Since health insurance companies are not held liable for their bad acts in denying or slowing claims, they gain profit by denying claims for life threatening illnesses, which are usually the most expensive, until the person dies. For those illnesses that are long term and chronic, they benefit if the person can not continue working and is terminated by their employer, or they can not continue paying the premiums, or the insurance company can drop them at the end of the policy year. Contrast that to the case if I have an accident in my car and someone suffers long term injuries, the auto insurance company has to pay for the cost of that accident and those injuries no matter how long the injuries last and they have to pay even if they drop my coverage at the end of the policy period. [X] From: casey wheeler [mailto:[email protected]] Sent: Friday, September 25, 2009 1:50 PM To: MURRAY, RICHARD (ASEP AMS) Cc: [email protected] Subject: Re: NMC NPC Free Markets and Regulation Richard, man that was good. I graduated just a couple years back and you call that very well!! I am tutoring a couple student now in econ and have not go to these issues yet, but man does it make me feel good! (And thats why I am a dork...admititly :) ) obvisously, I dont really disagree with the facts but.. "...also used with the same arguments against Medicare and I do not know any doctors who do not take Medicare patients because the government is interfering in their practice, or patients who say the government is rationing their healthcare." I do however disagree with this. I know several offices and doctors that no longer deal with medicare or medicaid, and saw a sign posted in an office yesterday stating the local arthritis clinic is no longer accepting medicare patients... ?? Figure that one out, who not on medicare has arthritis THAT bad???? I have time and time again tried to get a product or procedure done on a pt and have had it refused by medicare because they dont "need" it yet, or some check mark wasnt put in the right place... medicare does ration care... _______________________________________________ Miatapower mailing list [email protected] http://list.miatapower.net/cgi-bin/mailman/listinfo/miatapower
