Insurance companies may need to streamline their processes. They should be more vigilant and it is time for a re-haul of procedure and diagnostic coding.
I agree, but keep in mind that a lot of matters related to coding are due to federal regulations. Coding changes usually have to go through the “bureacracy”.
I suspect that an insurer might decline the second round of tests due to the fact that the tests had been done within the same year and were not ‘medically necessary’. If the claim was denied then the physician’s office would have to submit documentation that would support the decision to have the second round of testing and I suspect that they might, at that point, be reviewed and the charges allowed depending on the urgency of the medical situation.
I suspect that they already do turn them down, but the physician knows how to check the “urgent” box. So, the test gets done anyway.
Much of this is due to the fact that doctors and hospitals look at giving information outside of their office or network as “giving information to their competitor.” On large US State I am working with wants to, for example, set up a centralized patient master index and record system. Part of the reason they want to do this is because they don’t even know, even among the various state hospitals (that are supposed be a single entity) if a patient has been treated at more than one facility. That’s fixable with technology, just getting all the state hospitals on the same system (today they each have their own).
But, extending that outside of the state hospital group is another matter entirely. The private hospital chains view the state — — and each other — as business competitors, and the patient is their customer. They have no intention whatsoever of sharing customer information with their competitors. So, patient care suffers everywhere, because organizations won’t pass records and (more importantly for clinicians) nobody can do analytics over entire patient populations.
Let’s face it, if fraud affects your bottom line (and it does) common sense would dictate that you root it out. The government has a notorious reputation for side-eyeing fraud until it reaches epidemic proportions.
You’re being nice. They also have a reputation for participating in it. A lot of fraud schemes involve payoffs to bureaucrats.
For the people that are currently living paycheck to paycheck an HSA might not be a possibility, if so, it may be a conversation would need to take place concerning raising the minimum wage…?
Nah. This is just a subsidy with a different nuance to it.
It’s easy, statistically, to say to a person or family “ok, if the parent(s) are X and Y ages, and you have two kids of A and B ages, then (plug into formula) you need to put $Z into your account every month. Now plug in your annual income. Income too low? OK, the government will slide part (or all) of that monthly in there for you. And if anyone in the family has special needs, you check that box, and the amount of money gets adjusted.
Then, remember that these policies have a 10K annual out of pocket maximum (or whatever). If shit then happens, the HSA account turns into a revolving credit line. So nobody gets turned away because their kids break bones in two consecutive months.
There is no perfect solution but there are better steps that can be taken they just need to see the light of day so that Americans have as many options to consider as possible.
I agree. And as I said previously, right now, everyone is thinking “in the box”. Dems have an almost sexual fetish with single payer; this fetish has already cost people their lives. The GOP is determined to put forth a program that underfunds the lower income brackets, which would also cost people their lives.
Neither party has the conjones to just say “OK, you want good health care? It’s going to take a boost to the payroll tax. Period.”
You can’t do this by just raising taxes on the rich. There’s not enough money there.