What's going on in California?

[bpence]

Re:health care reference (RANT ON)

I'm mostly with Mark on this issue, it's not totally broken. I've seen both kinds of insurance companies....those who seem to care and want to help out, and those who could give a rat's hiney....and in our case it was different parts of the same company.

Several years ago our company encouraged all of us to use HMO type plans to save money and supposedly improve patient care, so we switched from traditional Blue Cross to BlueCare Network HMO. Due to where I live in relation to where I work, it ended up that we had to travel 30 miles to see a primary care physician. When my son needed his tonsils removed, we had to see three different doctors to finally get the operation scheduled and he only operated in a hospital 60 miles from us. Then the HMO sent us the whole bill stating we weren't properly enrolled through my company. Nothing like getting an $8,000 bill a few days before Christmas. It took 6 months to get it straightened out, and that's after the hospital sicked the collection people after us and they wanted to garanshee my paycheck. I got out of that plan as quick as I could.

We've also experienced the good of "good old Blue Cross" - not the HMO type. From broken bones to sports injuries to problems 100's of miles from home on vacation, they've taken care of us, when needed. When my daughter had an intestinal problem a couple of years ago and required 10 days of hospitalization, it was just handled. Our family doctor, our choice of hospitals, the best specialists available. No complaints, just kudos.

My brother-in-law is an oncologist and often talks of the difficulties in dealing with the insurance companies and HMOs in today's environments. He hates doing work on referral from the HMOs. He's sort of the last resort for a lot of cancer patients and really has tried to stay on the true leading edge of technology and treatment for cancer. This costs BIG BUCKS. The HMOs want to pay a "standard" referral fee and very reduced fees for treatment....very specialized treatment by the way. I hope doctors leading edge doctors like him are able to stay in practice in case one of us ever need those specialized medical services. The only way his group is able to stay up with the billings and collections is to use an outside service that specializes in medical billings and collection. Pretty sad state of affairs.

Our system may not be perfect, and I hope the folks that know about medicine and patient care are able to come up with ways to improve how the insurance companies, HMOs, PPOs, etc and doctors and hospitals work together. I sure don't have the answers, but I hope somebody can figure it out.

I was an EMT for a while and have a warm spot in my heart for the nurses and doctors that take care of folks coming into an emergency room. If you haven't been there on that firing line, you can't believe the dedication these folks have to what they do. It would be sad to see someone requiring a VISA card before they'd touch an incoming ER patient.

I know how to change the oil on my Kubota, but sure don't know how to cure cancer.

Seems like this thread has drifted a bit from the lights going out in California.

Bob Pence

 

[alexcocco]

Re:health care reference (RANT ON)

bob,
sorry i seem to have stirred the pot a bit about healthcare, but then again i have spent my entire career in a rural area taking care of people many of whom have no health coverage and have become the flotsom and jetsom of our society, mostly because of corporate and political greed.

alex

 

[Bird]

Re:health care reference (RANT ON)

<font color=blue>only way his group is able to stay up with the billings and collections is to use an outside service that specializes in medical billings and collection</font color=blue>

It really would be nice if a doctor or hospital could find one of those services that hires someone who can add and subtract with the aid of a calculator. But apparently such a service does not exist, and since they can't do simple math, they don't want the patient to see any of the bills and the numbers they've made up. Oops, I should stay out of this discussion, but after the last 6 years, I'm so disgusted with doctors and their billing services that I think outlawing "billing services" is the first step needed.

Bird

 

[cowboydoc]

Re:health care reference (RANT ON)

Bird,
I couldn't agree with you more about billing services. I had a contract with one because when we got hit with managed care my staff couldn't keep up with the rules, regulations, and paperwork. I was so disgusted at the way that they treated my patients for billing that I got rid of them as soon as the contract was up. Not to mention the fact that they got 10% of my gross off the top. I went out and found some good minds that knew what was going on and started doing my own billing and collections again. My patients were being billed for everything at the maximum prices even when insurance didn't pay by the billing company. Now I look at every bill to see what patients are having to pay that insurance doesn't and I usually wind up writing alot of charges off because insurance won't pay and I hate having the patient have to pay that much money out of pocket when they already paid a bunch for the insurance in the first place. We go to bat for the patients on getting insurance to pay their bills as well. I think this is what Alex was talking about when he said that we are the last line of defense for the patients. 2-3 hours of my day is spent on the phone to insurance, dictating notes, and doing paperwork just so that a patient can get insurance to pay their bill. It's almost seven here at the office and I've been here since 8 this morning and I still have more paperwork to do. Not saying any of this to feel sorry for me or any other doctor but just don't put us in the category of the insurance companies.

Alex,
You are so right about doctors leaving the field. There is a mass shortage of doctors predicted for the next 25 years.

 

[GrantMO]

Re:health care reference (RANT ON)

Richard,

Regarding insurance companies, there probably exist a few that are okay to deal with. But, by and large, what other industry gets away with so much? They routinely lose claims, deny them for procedural or punctuation or other trivial issues that they arbitrarily make up daily? I know of one company that threw away the claim form on every first submission as a matter of practice. They tell you one thing, then won't put it in writing. They often hire incompetent low level employees in an attempt IMO to frustrate providers into giving up and writing off claims. Doctors and hospitals and patients waiting for reimbursement wait 6,8 12 or more months for payment. In any other business this borders on fraud, but we as a country let it slide. Every state has the equivalent of an insurance regulatory agency but how many complain? Not enough.
Think about it this way....if a large insurance company can float enough money by using all the delay tactics above, they can reap millions in interest. That's what it boils down to. Money. Not quality assurance, efficiency or anything else.

Okay, I'll step off the soapbox now.

 

[Rch]

Re:health care reference (RANT ON)

In the USA 28% of health care dollars go to administrate it. Many countries, with a single payer system spend 7 to 9 %. Mass General Hosp has nearly 300 people in the insurance dept, Toronto General a similar sized and sophisticated hospital has 5 ! In this country insurance companies spend BIG $$$ marketing to low risk groups ( people who are healthy enough to work; renewing yearly so people who are high utilizers of health care are effective dropped by charging high rates, etc). All of this defeats the actuarial (mathmatical risk sharing of a LARGE group) foundation of insurance, leaving the uninsurable (the sick and elderly) outside the system for the gov't to pick-up. Remember, Medicare was created 40 years ago because insurance couldn't make money off them. Insurance Co. are spending health care dollars defeating the acturial basis of insurance and have created an accounting guagmire, often in collaboration with bureaucrats that are clueless to the technology and risks involved. Physician are subjected to onerous and useless documentation that is fickle, opaque and often changed retroactively in order to get paid MONTHS later a heavily discounted rate. I am very pessamistic about the future; Many seasoned docs are fed up and getting out early. Younger ones practice under the thumb of insurance company's threats and don't have the confidence and experience to prevent these companies from compromising a patients care. Patients are being discharged " quicker and sicker" and ending up back in( expensive) Emergency Rooms for re-admission to be taken care of by an entirely different physician who starts all over , again being pushed to get the patient out, not cure the problem! The accounting is so disjointed and fragmented that no one realizes this is costing big bucks. Good results are the cheapest in the long run.
My solution to the health care mess is to put every US senator and represenative on medicare and let them experience what every else go through. This red carpet service at Bethedsa Naval Hosp. insulates them to the faults of the system. I'd also mandate CEOs,CFOs etc have to have the same health as the lowest full time employee.

RCH

 

[cowboydoc]

Re:health care reference (RANT ON)

Grant and RCH,
Well said and true!

 

[Bird]

Re:health care reference (RANT ON)

Rch & Grant, I agree. A little over a year ago, I was one of those who went in for "day surgery", but then was kept overnight, sent home only to have to go back to the emergency room a few days later for more surgery and two more nights in the hospital.

And Richard, I didn't know any doctors still handled their own billing. Of course I do know as well as, and perhaps better than most, that there are good and bad in every profession. I've just seen more than my share of bad the last few years. And in fact, I called the hospital the 18th with a question about a bill, got a clerk who could tell me absolutely nothing except how much money she wanted from me, but I happened to have an e-mail address for one of the administrators, so sent an e-mail. The administrator replied on the 19th with the name of the person who will "call you today." On the 26th, I again sent an e-mail to the administrator asking "when did you say she was going to call?" I promptly got a response that the administrator was sending my message to that clerk's supervisor and that the administrator would talk to the supervisor in person Tuesday (yesterday). So today I got an e-mail from the administrator that the supervisor told her the clerk had called me and answered all my questions. I replied, "You've got to be kiddin'. I haven't heard from anyone at the hospital except these e-mail messages." So, once again I got an e-mail from the administrator that she will personally talk to that clerk tomorrow. But I wouldn't bet on it, because last year I couldn't get any answers until I wrote the Better Business Bureau with a copy to the hospital adminstrator. What they've done is screw up the billing so that I've paid the $300 deductible twice.

Bird

 

[cowboydoc]

Re:health care reference (RANT ON)

Bird,
You are right 100% and it happens to alot of people. What happens with the billing company though is that they hire someone off the street and give them a set of rules that pertains to your eob. If it's a problem different from their set of rules or what their computer shows then you are just out of luck. Then they start to make harrassing calls, send threatening letters, and send you to collections. That's why I took my billing back. I only have two doctors and some physical therapists at my clinic so it's not like the big physicians groups. I still have one full time person and another part time person though that all they work on is insurance and collections. When you consider salaries, work comp., and employment taxes I don't save alot but at least I can sleep a little better at night.

 

[Bird]

Re:health care reference (RANT ON)

Aaah, the infamous "eob"; something frequently mentioned by billing office personnel, but which they can rarely find, much less read or understand. I do sympathize with you on that. Of course, I'm old enough to remember when my employer changed insurance companies because the one we had sometimes took over 3 weeks to pay claims. Now we're lucky if it's 3 months. Sometimes I think nearly all professions are drowning in a sea of paper.

Bird