Just so tired of almost every time a doctor submits stuff to insurance, we have to be the ones to make multiple phone calls to both the doctor’s office and insurance to iron everything out, figure out what the issue is (it’s always a different issue), and basically be the go-between for the office and insurance. What am I paying $500+/month for?! It’s like paying for the privilege of having an exhausting part-time job.
And yes, I understand that insurance wants to weasel out of paying anything, but this isn’t even shadiness, just straight up incompetence and lack of communication/following procedures. The amount of emotional energy we have to spend untangling this stuff leaves us drained.
One of the biggest advantages I see from living under single payer health care is that I don’t have to put in extra clerical work like you describe. Sure, the insurance company should be able to pick up a phone, but In my opinion, the responsibility should rest on the hospital - they are the ones demanding a payout.
I completely agree about it being the providers responsibility. The problem is, they don’t want to do anything to resolve the issue either. Other times, it doesn’t even involve the provider, they did everything right but for some byzantine reason it didn’t go through the insurance system correctly and you have to call them and tell them to process it the same way they have processed every other exact same bill from the exact same provider.
Just wanted to vent. I should clarify I live in the US (as if that wasn’t clear from my post LOL!)
they don’t want to do anything to resolve the issue either.
In any other line of work, that’s an excellent way of forfeiting any right to getting paid.
In the jobs I’ve had where I’ve had to bill someone, I’m having a hard time imagining that I could expect to get paid if I just sent a bill to someone who didn’t owe me.
I worked in healthcare tech for a long time and I would say that healthcare facilities should focus on delivering healthcare. We had so much administrative overhead from dealing with this insurance bullshit that it drove up costs to staff a ton of people to deal with insurance bullshit and thus increased costs. If we had single payer it would be a single process that couldn’t possibly be more convoluted than what we have now. Sending shit to insurance clearing houses with exact ordering of diagnosis matching procedures so that they don’t get kicked back. The hospital doesn’t want you dealing with this shit either they just want the money that the insurance provider said it would pay for your treatment. It’s 90% insurance bullshit all the way down.
Just to offer another perspective, this covers just how difficult the burden of administrative tasks already is for physicians: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522557/
Not all physicians work for a hospital, so I don’t think they all have much access to large departments that can take up the slack for them. It’s difficult to ask them to chase our insurance for us when the paperwork they already do is driving them insane and taking them away from their patients.
The solution, as you said, is single payer. The overwhelming administrative overhead is a symptom of a very broken system. Nobody directly rendering or receiving care is benefiting from how things currently are in the United States.
It is unique to the way healthcare works in the USA. I don’t know why, the complete system looks broken. I can only tell you we pay less for healthcare here in Europe and we don’t have to call unless it’s really complicated and a rare situation. I’m sorry if that sound a bit off and doesn’t help…
Several decades ago in the USA, healthcare was affordable to working class people. It wasn’t cheap, but it was at least affordable to middle class people. It certainly wasn’t great even back then, because in my view healthcare is a basic human right. And poor people (especially minorities) had limited or no access. But even then, it was still better than the shit show we have today.
Anyway, what happened was some large corporations like IBM and others started offering an executive perk they called “major medical”. This was to help pay for expensive, unexpected medical expenses. It was a nice perk for the country club set. But like anything with money attached to it, some people got together and said, “Gentlemen, how can we weaponize this and take ALL the money?”
So, over time, it became the “standard practice” to tie your health insurance to your employer. This introduced a ton of friction into the system and created an entire ecosystem of rent-seekers who add no value to the patients or providers but charge a fee just because they exist.
Hmmh. I recently learned about that. Seems to be roughly 1980 (Reagan era?) when things started going really sideways and nowadays it’s just bad beyond words…
Source: https://en.wikipedia.org/wiki/Healthcare_in_the_United_States
That graph is depressing and familiar. It’s insane how we think we’re “the greatest country” in the face of cold embarrassing facts.
I’ve seen that graph before. One of the ways I interpret it is that as one ages we contribute less (money) to the system, mainly in taxes, SS, Medicare taxes. When we become old and retire we become a burden on the system that we’ve contributed for decades. The “system “ whoever that may be no longer cares about our health and longevity because they already have their money and the lower our life expectancy the less they have to pay out. Collect for decades only to pay out for a few years and we die up to a decade earlier than other countries on average.
Yeah, I’m in EU and I have never ever contacted my health insurance since the day I chose it. They just send me new insurance cards every couple of years and once they sent a letter that said they have an app that lets me get doctors appointments more easy etc.
Sounds to me like either your doctor’s billing department or your insurance company sucks. (Or both)
In the decade I’ve had my current insurance, I don’t think I’ve ever had to call them.
I still think our healthcare system is absolute bullshit, but I don’t think this is a specific problem inherent to it.
My insurance requires me to take personal action a couple times a year to say I stilll need to take the same medication I have taken for a decade, and that the other cheaper generics don’t work. They won’t take this answer from the doctor’s office and won’t stop asking.
They also don’t provide the pharmacist with a clear error that this is the reason they deny filling a prescription. I have a reminder now each year that I will be denied that month because of this bullshit and that I need to call.
Also, I can’t call early.
I wish I could Thanos-snap the entire health insurance industry out of existence. It’s a giant, bloated, bureaucratic middle-man that makes the whole process more expensive, time-consuming, and complicated.
I’ve wondered what would happen if people went on a health insurance strike. If everyone (or a large part of the population) cancelled their health insurance, and just negotiated on price directly with providers.
I’d imagine we’d see insurance invest money into making offers to providers. They’d refer the patient to a health insurance company instead of negotiating, and in exchange they’d get a large one time payout for a successful referral. This would please investors in the providers, because they’d see short term gains, and it’d please the insurance company because patients would be forced to have insurance again. Everyone (with money) wins!
If you fail to run the gauntlet, or give up in frustration, the insurance company doesn’t have to pay. They could absolutely make this process easier, but the incompetence works in their favor.
I’ve lived in single payer countries as well as in the US, and the incompetence is the same everywhere. In my experience the big difference is in universal healthcare countries the rules are very strictly defined and there’s very little scope for exceptions, so either you qualify or you don’t. The other issue is that even if you qualify there’s often a multi-month waiting list for treatment.
