With the cost of delivering quality healthcare on the rise, insurance companies continue to add to the problems facing physicians nationwide. Many people believe doctors spend the majority of their time on golf courses while earning millions of dollars. That may have been true in the past, but today there are formidable obstacles preventing those that provide care from collecting their fees. These days many physicians are forced to write-off a large portion of revenue due to the unreasonable practices of insurance carriers.
Insurance companies employ teams of representatives responsible charged with the receipt, processing, and servicing of insurance claims. When healthcare providers submit insurance claims, they are forced to follow-up vigorously in order to ensure that they receive reimbursement. The process of submitting and following up on claims is marred with holes and inconsistencies making it difficult to communicate with insurance carrier representatives. After navigating through a maze of automated responses, healthcare providers and their billing representatives are lucky to actually reach a live person. Once reaching a representative, all the information previously submitted must then be re-verified as if none of the previous entries were recognized.
As if the process had not been time consuming and difficult enough, healthcare professionals usually realize that the person on the other side of the line only has basic information available to them. What’s worse is that they usually expect providers to simply accept the lack of information available and move on. In most cases, providers and their staff must demand the help of a supervisor just to receive any sort of reasonable insight in to the matter at hand. What’s funny is the consistency with which these “Insurance Company Supervisors” seem to have more detailed information available to them. In the end, it often takes more than one insurance company representative and 45 minutes of time to receive relevant information pertaining to just one insurance claim.
With this being the case, one can see how the term “wasteful healthcare spending” is so common today. It seems as though the insurance companies are wasting time and money every day. Insurance companies profit billions of dollars each year while making it extremely difficult for healthcare providers to receive reimbursement for the services they perform. Even after healthcare providers verify coverage and obtain prior authorization, insurance companies still delay payments and deny claims.
A recent report from PriceWaterhouseCoopers states that “inefficient claims processing” is the second largest are of wasteful healthcare spending, costing as much as $210 billion annually. The New England Journal of Medicine reports that billing and overhead expenses consume as much as 43% of a physicians annual revenue. With statistics that these, it’s no wonder the cost of healthcare is spiraling out of control. Insurance companies are profiting while individuals can hardly afford coverage, and helathcare providers find it hard to turn a profit. Surely something is wrong.
Although healthcare professionals are focused on reducing costs and expanding coverage, they cannot do it alone. If we are to be successful controlling the rising costs associated with healthcare, insurance companies and government regulators must commit to change. Only through a concentrated, coordinated effort will we achieve affordable healthcare.
