Tag: insurance

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One of the continuing irritations with the present medical system is the administrative confusion that arises when it is time to pay the bill. For some reason, the provider and the insurance company make me the middle man in their struggle for payment or for non-payment as it were. Now the only value, to use corporate speak, that I bring to the argument is I don’t want to pay the bill.

Nonetheless I am continually being dragged into these discussions where my growing irritation is the only clear relevance I am bringing to the debate.

My participation usually begins when the provider, after numerous attempts, has failed to get payment from the insurance companies. They then decide to bill the patient which seems fair and reasonable as the patient ultimately received the service.

Let’s stop here for just a moment. I thought that this was a service that was paid for by my insurance company. I never expected to be billed more than the co-pay. All I can add to the discussion is I didn’t expect to be billed. The provider, rather cleverly, has pulled me into the argument.

But why? I don’t know the arrangement between the provider and the insurance companies. I don’t know how the provider is supposed to code their bills in order to get payment. All I can do is complain to the provider for billing me which is where the provider explains their dilemma — the insurance company won’t pay.

Apparently the ire of the patient helps the insurance company to do the right thing. I grudgingly can accept this tactic although I am baffled why the provider can’t just work it out with the insurance company without involving me. I suspect it is based in confrontation avoidance of the young office workers tasked with resolving these matters. For some reason, they would rather piss off me over pissing off the insurance companies.

Any way, this is where things get truly irritating. The provider wants me to contact the insurance company in order to get payment. WTF. Why am I the one calling the insurance company? Why can’t the provider call them? I am embarrassed to say I fell for this little gambit numerous times mostly because I fear having to pay a large dollar amount bill.

So, I would call the insurance company who then tries to explain to me what the provider needs to do in order to get payment. I am not the one who needs this information. I am not billing them. I don’t care what the provider needs to do, the provider does. At this point I suggest that the insurance company calls the provider to explain. This is usually greeted with mumbles and vague promises to contact the provider. Speaking from personal experience this rarely happens.

Because the insurance company has provided me with some useful information that might help the provider get their money, I try to pass that on to the provider the best I can with the suggestion that they themselves might themselves call the insurance company to ensure I have my information straight. More mumbles and more promises. Speaking from personal experience this rarely happens. I know I repeat myself.

The good news is I have came up with a new strategy that sometimes works. I don’t pay the bill and you know the provider and the insurance company seem to find a resolution without involving me. It sometimes takes awhile but they eventually work it out without me paying a thing or becoming the middle man.

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United Healthcare is a good place to start when looking at the problems plaguing our healthcare system. Two things stand out $24 billion dollars in profit and the highest denial (33%) of service rate in the business. Profits are a part of the American healthcare system but it would seem that $24 billion is a bit unseemly particularly when many Americans find it difficult to purchase healthcare insurance due to cost. The company could surely get less in profits so that more people are insured. Oddly enough, it might even bring more revenue into UHC as the more people insured by UHC, the more money coming into their coffers. .They could cut their profits by just a billion to test it out with little harm done to anyone.

Then there are the denial of service rates. If people loved Healthcare insurance companies and thought they were doing their job fairly then I could actually live with $24 billions in profit. But they aren’t. People are so mad that security experts couldn’t understand why Thompson failed to have a security detail. He was a sitting duck for any assassin.

Let’s think about that for a moment. A CEO of a large insurance company is putting his life at risk simply by walking the streets of New York. If people want to kill you because your company’s treatment of its customers is so bad that a few are willing to throw their own life away to kill you should be a wake up call. At the very least, your company has failed to do a good job explaining its processes and procedures to its customers and, at the worst, you have been caught bilking your customers for money. A good portion think the company is screwing with them to save money. How else do you explain $24 billion in profits and industry high denial of service rate? I haven’t heard a good explanation yet.

Here is the saddest fact of all — the awful reaction to Thompson’s murder. A lot of people are OK with it. If nothing else shocks the insurance industry, this should. Your reputation is in such disrepair that people can live with insurance executives getting murdered because these same executives don’t seem to be reacting to the genuine need for people to have their healthcare paid for at a reasonable rate. They are tired of the large expense and they are tired of fighting with insurance companies over unpaid bills. What are they going to do about it?