By way of Jesse Taylor, imagine that you had $16,000 of bills due to an appendectomy:
If it's not paid in fourteen days, it'll go to collections. (Keep in mind that my yearly budget, courtesy of the law school, is a little over $15,000.)I call the hospital, and am told that the claim was submitted to my old insurance company and denied because I was not covered on the date of service. I cannot do any sort of low-income write-off plan unless I cancel my health insurance and am denied from both Medicare and Medicaid. Even then, it's conditional.
I call the insurance company and was told that I was not only covered on the date of service, but am still covered by the insurance, despite canceling it in August of 2008. I try to confirm that it's canceled, and am told that I have to submit a request through a separate service by mail. They ask me to have the hospital resubmit the claim by fax.
I call the hospital back and tell them this, and they tell me that they won't resubmit the claim, as resubmitted claims are almost always denied. They ask me to call the insurance company and request a re-bill of the claim of the hospital.
I call the insurance company back, tell them this, and they tell me they can't request a re-bill, because they don't do that. Ever. They will, however call the hospital tomorrow and request the resubmission of the claim...I hope.
But really, a government run healthcare health insurance system would be a disastrous bureaucracy that would...blah, blah, blah.
Anyway, I'm sure Jesse deserved his appendicitis. Irresponsible slacker.
Seriously, other countries can do this, and at lower cost. American exceptionalism, my ass.
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Clearly the problem here is "gold-plated" health care plans whereby people like Jesse Taylor receive appendectomies they don't need. I propose we move to a more "market-based" health care system where patients are responsible for their own choices; under a system like this Mr. Taylor would have spent the time he had appendicitis comparison-shopping for surgical procedure providers, and then might well now owe only $14,000.
At least we can breathe a sigh of relief that President Obama has not given these very same insurance companies a prominent seat at the health reform table, nor has Senator Kennedy conducted secret meetings to craft legislation with insurance companies.
The fact is, if the entrenched interests are not "given a seat" at the table, then they will simply keep doing what they are right now, which is to control the policymaking process behind the scenes with payoffs to legislators.
14 days!? I've never met a health care provider in the last few years that could process the invoice faster than two months! Between that bookkeeping and the insurance claims, I usually try to give 4-6 months for all the bureaucracy to settle out before paying a bill. About half of the time that still isn't long enough and I wind up under or over paid as compensations and billing amounts are adjusted, post formal invoice.
If you really want to see something, ask for a quote before medical service. What's this going to cost? How much do you charge? Most only work up final charges after insurance compensation is realized or refused. Charges are often adjusted based on level of insurance compensation, or lack thereof. This would be fabulously illegal in any other line of work. Why do people oppose fixing this?
The fact is, if the entrenched interests are not "given a seat" at the table, then they will simply keep doing what they are right now, which is to control the policymaking process behind the scenes with payoffs to legislators.
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The fact is they would be doing that is they were given a seat at the table. Whether they are given a seat doesn't matter in this regard. It is what they do.
A co-worker is currently dealing with the Social Security Administration regarding his mother and his aunt. His time has been full of stories just like that.
What's even crazier is that if Jesse's insurance had paid up, they probably would have sent roughly 40% of what was owed and the hospital would have happily accepted it along with whatever co-payments Jesse paid as "payment in full". In what other business can people pay you less than half of what you invoice, and call it done? Think I could do that with my mortgage?
This story is yet one more anecdote suggesting that for-profit health insurance companies are part of the problem, not the solution.