In all fairness, providers do bill the same rate
for all regardless of whether or not the patient has 3rd party coverage.
Because the big insurers control so much of the market and set their own payment
rates, as do MA and Medicare, providers are stuck. Either they can accept the
lower payments, both contracted and mandated, in order to be able to serve the
greatest number of people in the community or they can choose not to accept
assignment. In which case, the patients will go elsewhere.
Maybe providers should take a stand and not accept
assignment. This is the case with Mayo Clinic and medicare--at least it
was several years ago when I worked there. At that time, medicare patients
signed on to be responsible for the entire bill and would have to work with
medicare and any supplemental insurance company in order to be reimbursed for
the bills they paid to Mayo. They might also be able to apply for some
assistance with the clinic, but it was most definately "means tested" or
something that patients would have to prove they are deserving of. Let me
tell you there were a lot of older people confused and furious about this.
They expected that Medicare was supposed to be there to make sure they could get
the care they needed--most likely from the world renown medical facility in
their back yard. And they didn't understand why Mayo wouldn't just bill
insurance just like always.
Patients don't understand that clinics bill 3rd
parties as both a courtesy for the patient and to assure better collections for
themselves. Maybe they understand this more so now than in times
past.
As a result of these kinds of policies--refusing to
accept assignment of benefits--there seems to be a huge class
difference between the patients at Mayo Medical Center and those at Olmstead
Medical Center and Medical Clinic. Fortunately the care in both facilities
is top notch--no thanks to the US health care system, but to the providers who
are dedicated and professional.
This situation reminds me of health care in
Mexico. There are private hospitals for the rich and public hospitals for
the poor. Can you guess which one we took a member of our travel party to
after her accidental injury? Not the public one!! My fear is that if
the finest qualtiy providers decide not to accept assignment of MA or Medicare,
but will agree to the big blues' rates for everyone, we will begin to see the
same kind of class divide here. It seems to already happen with
dentists. So very few accept MA clients that it is really hard for poor
and disabled folks to receive dental care that they need. And uninsured
folks can be caught between a rock and a hard place, too, regarding dental
care.
So, as you can see, I think the answer has a lot
more to do with breaking up the monopoly that those big insurance providers seem
to have. Maybe an overhaul of insurance just like the telecommunications
industry went through a few years ago? Just my rant for today--sorry so
long!
Kathy Seifert
