What’s wrong with healthcare…
What’s wrong with ….
What is wrong with America’s health care system? That is a loaded question; it is sometimes easier to tell you what is working correctly with our health care system than to tell you what is wrong. Nonetheless, I will give it a stab. It’s a compound answer one that would elude to administrative overhead to the cost being inflated due to unnecessary testing being order by doctors to convert themselves from Insurance carrier and lawyers law suits.
From the administrative overhead point of view the insurance carrier in an effort to try and find a way out of not paying a claim wants additional documentation. Which requires additional work to be done that will raise the cost of doing business with insurance companies. An example of this is the paperwork that you need to submit along with a 1500 claim form. Let’s list the forms that you would have to submit when filing a claim with an insurance carrier of course this is for a massage therapist office submitting a claim which may be more than a normal doctor’s office but I would like to speak from experience rather than speculation.
The list of documentation needed to support a claim filed with a doctor’s prescription, the intake forms, the billing requirement documentation, and notes that the therapist took during the session to make sure that the work coincides with the doctor’s prescription. Additional documentation could be streamlined by using electronic documentation and getting rid of documentation that is really not needed. A typical claim for a major insurance claim would include: 1500 Claim form, Prescription or Letter of Referral form, Release of Records form, Payment Agreement form, Assignment of Benefits form, Initial Evaluation/History intake form, Muscles Involved in treatment form, SOAP notes from therapist and any additional documentation that was done during the appointment or session.
All of this paperwork adds overhead to the therapist in a small office such as paper, files, envelopes, postage, and the endless need to document every move that is made in the office with the patient. As the office grows additional staff would be needed to be able to handle the additional paperwork and making sure that the therapist takes the time to document everything for the insurance carrier. Add to this additional procedures may need to be done or ordered by the referring physician that may not really be necessary based on what the patients needs are simply because the physician is trying to make sure that malpractice does not come into play.
In a hospital environment, a physician may from time to order up un-necessary tests simply to bill insurance carriers because they have not made enough money lately, or because they need to bill additional money to the insurance carrier to make the process worth their while. Not because the patient really needs the test done but because maybe a procedure rules call for the test to be done. Insurance carriers group codes into groups for overall procedures like the removal of an organ. Let’s say that a group of codes include a supply of forceps that are charged to the insurance carrier and during the operation these forceps are not used during the procedure. Would the physician office simply file for the operation and remove modify the code to tell the insurance carrier that they did not use the forceps in the operation or is it easier to simply report the operation in full.
This has been the transition from insurance carriers telling the physician what they should be doing instead of the physician telling the insurance carrier what happened. Just like every person is unique on this planet every procedure that a physician does should not be cookie cutter or assembly line in nature. Making treatment more streamline and efficient would help cut costs from the healthcare system.
My opinion of the healthcare system in the United States could be better than it currently is by giving back the power to the physician and out of the politician’s hands. When a powerhouse such as insurance carriers or politician’s gets involved in healthcare it simply complicates matters. Whatever happened to the doctor that makes house calls or the doctor that took time with their patients to talk to them and really gets to know them? Today’s medicine is so assembly line that a doctor only spends a max of 10 minutes with a patient in a regular medical office because the insurance carrier will only pay for fifteen minutes for the doctor’s time to see the patient. I applaud those doctors that spend more time with their patients and wish more doctors were like that.
If we all were actively involved and stood up to the insurance companies in the world we could make a change for the better. There is simply not enough people that have the time or knowledge to be able to make a change at this time.
