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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: John Koligman who wrote (6188)	2/26/2009 10:00:53 AM
From: i-node	3 Recommendations Read Replies (2) \| Respond to of 42652

Insurers are the PROBLEM bigtime, they play games, they take all the premiums but when it comes time to pay, they delay, they have 45 days to pay then are supposed to pay interest, they never do moreover, they will let claims sit and you have to go after them tooth and nail for less than $100 and still they delay- we need one insurer, cut all the bs and red tape, if the diagnosis fits let the computer sort it out and none of the end of the month and quarter games they play so their numbers look goood- DONT GET ME STARTED The OP is correct on some counts. However, one must understand, the problem with MC and MA isn't so much the processing of typical claims -- it is (a) the fact that they don't pay a living wage for typical providers, and (b) anything OTHER THAN an atypical claim cannot be handled. At all. Because of the insane bureaucracy. So, while commercial insurers DO stall and delay and use every trick in the book to avoid paying, particularly on out-of-network providers, you CAN at least get a human on the phone to deal with a problem. If you have a problem Medicare claim, you may never see your money unless you're willing to spend an inordinate amount of time for the number of dollars involved. Obviously, you can spend more time trying to collect for heart surgery than you can for an office visit. Also, state Medicaids vary widely. Some are pretty good payers, others are terrible. Totally depends on the state you're working in. We service a 7-state area and 2 of those states are okay and the rest are train wrecks. Medicare is the worst bureaucracy of any payer I know of. But the main problem is that if a practice accepts Medicare they are taking a substantial cut in earnings because Medicare is the worst payer for every procedure, and for many they do not even allow sufficient money to cover costs. Here's an example -- a low-to-moderate complexity office visit (99213) is currently allowed at $43 in our locality. At 35 patients a day, a pretty heavy load for most physicians, that's is $1,500/day to run the office on. You're not allowed to mark up drugs or outside lab services, so there is no profit there. 60% of office visits are this particular code, while some are lesser codes and others are higher. This $43 has to cover the front office staff, the nurse who checks you in, the time spent documenting, HEAVILY, the visit, time spent in the room with you and writing orders and prescriptions, and the general overhead cost of occupying a building -- phones, computers, calling the plumber, medical waste disposal, etc. You just cannot do it. You can't keep a modern medical office open on these kinds of payments.