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This is an idea I have been wrestling with for some time, so I finally decided it was time to get others' opinions as to its legitimacy. I'm sure you have noticed upon receiving the paperwork from a health insurer regarding some specific procedure or event that was submitted to them for payment under your individual/family medical plan. Upon delving into the data under each of the many headings, one cannot help but noticing all the opportunities for real confusion. I mean there are over-lapping column headings, under which there are what can only be described as a "myriad" of numerical entries, including but not limited to such things as : dates, codes, bill amts., insurance responsible amts., patient responsible amts., insurance paid amts., patient paid amts., insurance adjustment amts., patient adjustment amts., and balance amts. To me, this spells the opportunity for errors and confusion. Have I said anything you disagree with or are confused by yet? What I am asking here is why do we have to pay insurance companies boatloads of money for such a product that is never simple or clear for any of us to comprehend? Now comes my biggest point. Because of the column titled "Insurance Adjustment", which is basically saying that this amount of the charge was negotiated by insurance company representatives as "FLUFF", or "INFLATION", and not intended to be received by the provider, but only to serve as a "show" of how strong these insurance companies were fighting for their policyholders, by their standing up to the providers and demanding a lower price for these patients. I say this is all B.S., and it is also the real reason why the U.S. has the highest medical costs in the world, far in excess of other developed nations. And the saddest part of it all is how this affects the UN-insured. They are charged the "Bill Amounts" and expected to pay what the insurance companies have negotiated as the pre-"insurance paid" amounts, when, in reality, the provider is willing to for-go a good percentage of this amount for all others that actually have insurance coverage.
So let me now state exactly what it is that I am suggesting. I am challenging our politicians to undertake the task of eliminating "health insurance coverage" as it now exists. Providers play a HUGE role in this as well, by their having to overhaul their entire cost systems. They need to charge patients, not insurers. Patients are their lifeblood and will always be. These providers have a right to profit from their services, but not to profit insurers. They have proven through their actions that they CAN and DO make a profit by accepting what the insurance companies are willing to pay. So why not have these specific amounts actually be the charges for their patients and let the patients be responsible for paying the bill? The patients COULD hire an insurance company to HELP them pay what they might have difficulty paying, or for those "unexpected" tragedies or illnesses, and it would be a smart thing to do, but NOT required. However, the big change would be two-fold: 1. Patients would be billed for everything, not the insurance companies, and it would be the patients' responsibility to pay what they could first, before submitting the remainder to their specific insurer IF they choose to have one. 2. The total charges would be some reduced amounts, certainly much closer to what the insurers now pay, and thus the billing levels would be drastically reduced. This would put the U.S. more inline with the other developed countries in this world.
Just as an example of what I am saying, let me show you a specific example from a recent billing I received:
Code: 88305 Bill Amt: $1,054.00 Ins. Responsible: $1,054.00 Ins. Paid: $246.25 Ins. Adj. $807.75
Obviously this left me with a balance of $0 for my colonoscopy, BUT look at the adjustment the insurance company received: 76.6% !!!
I sure hope this helps you see my point. I will appreciate your comments.
In addition to the above words, let me add this additional point that I originally forgot to include: In addition to what I am recommending, I also propose that we leave Medicare and Medicaid untouched. This will leave the door open for existing insurance companies to handle the needs of those who choose to carry supplemental Medicare coverage, and that will take some of "heat" off those companies who's businesses have lessened because of the way I suggested the payments should be the responsibility of patient, and NOT insurance companies. I am NOT against insurance companies, just upset about the way they "inflated" the charges for many, many years now.