Consider that the author is only discussing his portion of bureaucratic obstructionism. Pharmacies, labs, and imaging departments also have their time sucked up trying to decode it all on the other end. In my own experience, if I didn’t have to spend so much time trying to make sure that all of the insurance stuff was correct, I could perform several more exams every day.
There are entire companies that are subcontracted to do preauthorizations for the insurance companies - whole building full of people whose job is to impede the process. Because that’s fairly obviously the point of it all, for anyone who had to deal with it.
The goal is to force one of two outcomes: 1) make patients and providers simply give up, and not try to receive drugs of services for which they’re covered, or 2) make the provider or hospitals eat the cost because they’ve made some mistake in the process, causing denial of payment.
This is the sort of dystopian bureaucracy that inefficient governments can only dream of.
BTW, any responses to this that touch upon Canadian health care will only be accepted if they’re made by qualified American posters. Canadians may provide their opinions only after receiving preauthorization. PM me to get the 800 number to call and request the form.
I am confident that the imminent massive influx of revenue to health insurance providers will allow them to provide the service they so obviously want to give.
Dude is ranting about something we experience in many industries…trying to get customer service thru automated platforms - I feel his frustration. But making that leap that insurers are the reason for the high costs is asinine. Would love to see how he is breaking down the 30% administrative costs…we consume more HC than other nations thus the cost is higher. We typically don’t ration, we have more treatment options. And the biggest cost driver of all is Medicare/Medicaid which is 60% of all hospital admissions and of course which for the most part to not cover costs so the the rest is shifted to everyone else meanwhile this group is growing. And of course, Americans are generally fatter and have more preventable chronic illnesses than other Western nations.
Except that you’re assuming that the automated platform’s existence is useful or even necessary. What purpose is served by putting so many people and so much effort into second guessing every decision about every patient?
It’s an arms race between the insurers and the providers - look at how many support staff are required for each doctor, each pharmacy, and each imaging department.
Except that you’re assuming that the automated platform’s existence is useful or even necessary. What purpose is served by putting so many people and so much effort into second guessing every decision about every patient?
It’s an arms race between the insurers and the providers - look at how many support staff are required for each doctor, each pharmacy, and each imaging department.
And remember that you’re paying for both sides.
My contention that the govt is the biggest reason for all the extra people pushing paper at all levels of HC, this is an extremely highly regulated business - the govt sets the rules. Look I deal with hospitals every day for work. I am also a patient with a chronic illness. I have my insurance with Cignet, for the most part they have been extremely responsive. There was one time when I had an issue, but it wasn’t a business strategy not to get something paid, it was for care out of the ordinary, it required more explanation and at the end of the day they provided the care.
BTW, any responses to this that touch upon Canadian health care will only be accepted if they’re made by qualified American posters. Canadians may provide their opinions only after receiving preauthorization. PM me to get the 800 number to call and request the form.
The government never even suggested that insurers require preauthorizations for everything. The insurers invented that all by themselves.
As for Cigna’s smooth and efficient workings: the inefficiencies (all of the people and man hours) are not out in plain view of you, the patient - but you are paying for them.
BTW, any responses to this that touch upon Canadian health care will only be accepted if they’re made by qualified American posters. Canadians may provide their opinions only after receiving preauthorization. PM me to get the 800 number to call and request the form.
PM sent.
I’m sorry, but we can only send the form you requested to addresses in the continental United States. You need to call the number again, but this time press “4” on the main menu.
BTW, any responses to this that touch upon Canadian health care will only be accepted if they’re made by qualified American posters. Canadians may provide their opinions only after receiving preauthorization. PM me to get the 800 number to call and request the form.
PM sent.
I’m sorry, but we can only send the form you requested to addresses in the continental United States. You need to call the number again, but this time press “4” on the main menu.
Your 1-800 number doesn’t recognize my non-domestic cellphone number for proper routing through the menu system. Are you saying I need to go and find a bloody landline to call you?
The government never even suggested that insurers require preauthorizations for everything. The insurers invented that all by themselves.
As for Cigna’s smooth and efficient workings: the inefficiencies (all of the people and man hours) are not out in plain view of you, the patient - but you are paying for them.
You are also getting the benefit of the company making sure they only pay for claims that are authorized by the policy. You can rail all day about overhead at an private insurance company but these costs are peanuts compared to what is truly driving up HC costs.
I posted this in another thread yesterday…but I will repeat it for you.
Insurer profits: a reality check
Insurance industry profits are not a significant driver of health insurance premiums. A Yahoo Finance analysis places the health insurance sector’s average profit margin in 2012 at just
4.5 percent. By comparison, major drug manufacturers have an average profit margin of 16.7 percent; medical instrument and supply companies, 13.6 percent; biotechnology, 11.9 percent; and medical appliance and equipment companies, 13.7 percent.22
Administrative costs represent less than 2 percent of health care spending growth. Private insurance administrative costs are actually comparable to Medicare’s administrative costs when comparing similar services. In 2009, private payers expended $12.51 per member per month versus $13.19 for Medicare.23
Importantly, private insurer administrative costs include fraud detection, disease management, wellness programs, and investments in information technology.
BTW, any responses to this that touch upon Canadian health care will only be accepted if they’re made by qualified American posters. Canadians may provide their opinions only after receiving preauthorization. PM me to get the 800 number to call and request the form.
PM sent.
I’m sorry, but we can only send the form you requested to addresses in the continental United States. You need to call the number again, but this time press “4” on the main menu.
Your 1-800 number doesn’t recognize my non-domestic cellphone number for proper routing through the menu system. Are you saying I need to go and find a bloody landline to call you?
We strive to provide a high level of service to all of our customers. So, yes.
BTW, any responses to this that touch upon Canadian health care will only be accepted if they’re made by qualified American posters. Canadians may provide their opinions only after receiving preauthorization. PM me to get the 800 number to call and request the form.
PM sent.
I’m sorry, but we can only send the form you requested to addresses in the continental United States. You need to call the number again, but this time press “4” on the main menu.
Your 1-800 number doesn’t recognize my non-domestic cellphone number for proper routing through the menu system. Are you saying I need to go and find a bloody landline to call you?
We strive to provide a high level of service to all of our customers. So, yes.
Ah fuck it. I had this very thoughtful reply to your post, but your bureaucratic ways leave me no option but to take my business elsewhere. I’m going to ask whether I should buy clincher or tubular Zipp wheels in the main forum instead of offering my contribution to your moribund thread.
You mentioned my peeve, PHrMA. These companies make profits waaay outside what businesses do generally, and of course were brought onboard to not fight Obamacare, and went on to spend >100million dollars in ads to promote the bill.
Dude is ranting about something we experience in many industries.
My thoughts as well. Ever try to get tech support, talk to someone about your taxes or any number of other regulations. The larger the company the bigger the PIA it is to actually get your questions answered. The more regulated and complex the company the worse it is.
The answer might be to de-regulate and localize…but hey, we want to add more regulations and centralize and think that will “Make it all better”.
I’ve often thought about what it might take to create a large local group that is both self insured, but largely self regulated, something along the lines of an “Employee owned” health care system. I suspect that neither the state not the Feds would allow this however.
You mentioned my peeve, PHrMA. These companies make profits waaay outside what businesses do generally, and of course were brought onboard to not fight Obamacare, and went on to spend >100million dollars in ads to promote the bill.
This might be the most confusing post I have ever read from you. You have an issue with a private enterprise providing value to a shareholder and Obamacare at the same time. You people don’t know what you want.
I’ve often thought about what it might take to create a large local group that is both self insured, but largely self regulated, something along the lines of an “Employee owned” health care system. I suspect that neither the state not the Feds would allow this however.
It’s been tried before and failed. Then they moved the group to Guyana.
Consider that the author is only discussing his portion of bureaucratic obstructionism. Pharmacies, labs, and imaging departments also have their time sucked up trying to decode it all on the other end. In my own experience, if I didn’t have to spend so much time trying to make sure that all of the insurance stuff was correct, I could perform several more exams every day.
There are entire companies that are subcontracted to do preauthorizations for the insurance companies - whole building full of people whose job is to impede the process. Because that’s fairly obviously the point of it all, for anyone who had to deal with it.
The goal is to force one of two outcomes: 1) make patients and providers simply give up, and not try to receive drugs of services for which they’re covered, or 2) make the provider or hospitals eat the cost because they’ve made some mistake in the process, causing denial of payment.
This is the sort of dystopian bureaucracy that inefficient governments can only dream of.
Taken as a whole, privatized healthcare is extremely efficient. Additionally, many insurance segments are held to a certain profit ceiling (MLR/MER) by State laws. As of 2007, the average US medical loss ratio for private insurers was 81% (a 19% profit ratio). Compare this to auto insurance, where the ratios show 40-60% profit margin. Pre-auth, UM, prospective/retrospective claims review are all valuable services and prevent fraud, waste, and abuse which would run rife if kept unchecked.