It’s funny you mention restaurants, in that case I don’t particularly care when they bill me because the menu says precisely what I’ll pay (counter order vs table service doesn’t matter as much as cost and quality). If it’s market rate (steak or seafood), they’ll tell me what the day’s rate is and what cuts they have.
We were talking about service, not cost… Like if they ran your card for every individual item, as soon as you ordered it. “I’d like to start with a coke to drink” takes out card to charge. “Then I’d like a starter” takes out card.
This is what i mean by bad service.
don’t get that with health care, even getting a range in a quote is like pulling teeth. I pushed back a ton when my daughter needed a surgery, and after several calls I still didn’t get a clear answer, and this was for a routine surgery. The quality and speed of service was great, billing was not.
This is likely because you called before a prior authorization was completed, meaning that you most likely were utilizing private insurance. If you were utilizing Medicaid, which doesn’t require pre authorization, then it would be really simple to tell you.
You can’t give an accurate quote for private insurance because the individual plans are so personalized by their workplace or insurance brokers to lower cost and coverage that we literally don’t know what your coverage until we submit if for authorization and equate for things like deductables and copay.
This authorization process requires not only a referral, but an itemized script, supporting notes, and a face to face with the provider. So unless they had the opportunity to complete these task, private insurance doesn’t allow us to give you a quote.
but you also often get delays in care.
Lol, you were just talking about a delay in care due to billing issues with private insurance. American private insurance also has the same exact delays in care, waiting weeks for prior auth, waiting months for people to meet their deductible, avoiding needed care because of cost, and just plain waiting for specialized care because we don’t have enough specialty providers. Many specialty providers like neurologist or or rheumatologist have left the field specifically because of paperwork burnout. The authorization process for these expensive specialty practices is so scrutinized by insurance companies that it can take months of daily negotiation to even see a patient.
I agree, the current profit motives are misaligned, and pushes like the ACA to further expand the number of people with insurance further entrench these practices.
Lol, wrong again. The plans allowed on the aca marketplace had to follow aca guidelines, which included automating the billing process. These platinum, silver, and bronze plans are actually pretty easy to work with compared to those offered by people’s workplaces. In the beginning we were actually pretty excited to see actual changes to the system, however since the removed mandate, and the subsequent deterioration of coverage in these plans, it’s rare to see patient actually utilize there benefits.
The profit motive should be attracting customers who otherwise would go without. But since pricing isn’t transparent, cash payers don’t have the same leverage to get a fair price. Many care providers have an informal “cash discount,” but that’s just not the same
What are you talking about about? Why would an insurance company want to attract uninsured people? The uninsured people of America are some of the most at risk communities in America. They are impoverished, underemployed, and are disproportionately likely to have long term health conditions. There is no wealth to extract from these people, and the longer they have been uninsured, the more likely they are to require excessive care once they are insured.
If the system works well for cash customers, insurance would need to earn customers’ business, but when most people have insurance, the patient is no longer the customer, the employer is, so they’ll charge individual customers more than employers with group plans.
Lol, you have no idea the average cost of healthcare people accumulate during their lifetimes. One serious stint at an inpatient facility would bankrupt a wealthy person. As I said, there is no profit in healthcare that isn’t created by denying healthcare.
Removing private insurance is one option, but that’s also quite disruptive and has potential for other issues (e.g. why would Medicare bother with good customer service if it’s the only option?).
Why exactly would it be quite disruptive? Also, Medicare is the only option for the people who have it… If you qualify for Medicare for your primary insurance, private insurance automatically becomes your secondary. Medicare still offers more coverage than any other private plan. I don’t think you quite understand that the people whom work in healthcare do so because they want to help people. Being a physician doesn’t exactly mean you’re making the big bucks anymore. There are plenty of fields that require a lot less schooling and pay way more.
That wasn’t my experience. We had two options for a surgery with different risks and costs, and after several calls, we couldn’t get any numbers, just A costs more than B.
As I said previously, this is an inherent problem created by private insurance. You can’t just call and shop around on private insurance, the way they set up the prior authorization process is expressly made to prohibit this. The only way to do this is to call your insurance as a subscriber, and talk to your plans agent. They will direct you to their preferred network, where they have negotiated cost previously.
Again, insurance companies purposely create inefficient and archaic systems so their customers won’t utilize their services as often. They make us do all the explaining and processing, so we get the blame.
should be able to get quotes on a procedure from multiple care givers for a non-urgent procedure (like the one we had).
I agree, and if your child was on Medicaid it would have been super easy… You would have been told $0.00. Medicaid is an actual healthcare system, and because their goal is to actually improve their patients health it functions as intended.
Patients should be able to switch insurance if they don’t like the one they have.
Right, but who is preventing people from switching plans… Oh yeah, private insurance. Because private insurance cannot afford to have patients switching insurance every time a patient has an operation. How are you going to remain solvent if a subscriber can just run up cost and then switch to a different insurance pool without contributing?
my company offers a crappy plan, I should be able to take what they would’ve contributed and pick my own plan. If that was the case, insurance companies would try harder to make their service more convenient, just like auto insurance does (not a gold standard, but much better), and HR orgs would probably try harder to pick better plans.
You are ignoring the fact that private insurance is a gamble. It’s a company gambling that you as an individual will contribute more to the insurance pool than you take out before you turn 65. If a person can just switch insurance companies they could just change plans every year they needed an expensive operation. The same can be done with home/car insurance, but car/home insurance is allowed to charge people with prior history of heavy utilization with higher fees and deductible. This is not legal in healthcare, as it would automatically price out people with chronic illnesses.
If you’re wealthy, you don’t need much from your insurance.
And how many people are wealthy compared to the amount of people who are poor? Is your solution to build the entire country’s healthcare system for 5% of the population? Also, why should your life savings be eaten up by healthcare cost if you already paid for life insurance your whole life? I just don’t see why you are so ardent about paying more money for less coverage?
I’ve run the numbers and can get a similar price (within 10% or so) for similar coverage without ACA subsidies,
You are comparing individual self funded plans to those offered by your work? As someone who owns a company and works for a hospital… I highly doubt that. I’m still utilizing my hospital insurance because the self funded ones offered to small companies were quite a bit higher when factoring in deductible and copays. If you were talking about individually funded plans, I would urge you too re examine the coverage.
they’d just adjust rates to compensate.
The amount they would have to raise rates exceeds their clients ability to pay… You can’t squeeze blood from a stone, and people are already struggling with their current cost. Raising the rate high enough to account for chronic disabilities isn’t an option. This is why they fought so hard against the law that prevented them from rejecting coverage for people with conditions like type 1 diabetes, which isn’t a disability that qualifies for Medicaid, but has a high cost.
Which is a huge part of why I’m a fan of government funded ER. That’s a huge risk factor for insurance companies and hospitals, and it’s also a huge complexity for visitors and whatnot, so it should just be provided.
That’s just a bandaid who’s only function is to protect insurance companies. If insurance companies are not good enough to cover emergent healthcare what’s their point? If you can get free healthcare at emergency rooms instead of being insured, why not just go to the ER? This would just make the emergency room problem worse.
Why spend so much time coming up with worse work arounds when you haven’t been able to tell me a single advantage private insurance brings to the table?