“considerable portion of each health dollar goes to insurance paperwork rather than actual care”
Most people have no idea what it takes to bill the insurance companies. Expensive software applications are necessary to navigate a very complex system of documenting the care and translating it into a bill. Even with the software many errors still occur because of restrictive, sometimes vague billing and coding guidelines that are set by insurance and the government. If the provider sends the bills electronically they also have to pay a clearing house that further prepares the bill into an electronic format that can be received by the insurance company. Then there is the issue of follow up on unpaid or improperly paid claims. As a health care biller for a hospital, my colleagues and I spend inordinate amounts of time calling insurance companies only to be told, after 20 minutes or more on hold, that they don’t have the claim on file even when we have sent it numerous times; electronically, by fax or even certified mail. We joke that the insurance companies keep a shredder in their mail room. But it isn’t all that funny. Between lost claims, data entry errors by the insurance companies, denial of what actually are covered services that we have to appeal and pre-authorizations we received that the insurance companies claim they did not give, it can take months to receive payment. Anyone who runs a business knows that timely payment is crucial. In most states insurance companies must pay or deny clean claims (that have no errors) in 30 calendar days, however, they seem to think it is 30 business days even when the claim has been approved for payment within in a week of their receiving it. If there are errors on the claim they have more time but, when the insurance company is the one who made an error, they will still stretch it out to 60 or 90 days before they will pay the claim.
I suspect that billing was easier back when most people only had major medical plans and paid for most or all of their own preventative care if they chose to get it. The demise of major medical plans and the inclusion of preventative care coverage has probably had a direct impact on the rising costs of health care. If we didn’t have to pay for the billing and the headaches that go with it as I described above, costs for most health care in general would be far less expensive for the consumers, insurance companies and the providers.
