Well, Mr. Smartypants and the School President have gotten their little healthcare reform bill passed.The only thing is, this wasn't reform, this was adding a bedroom onto an ugly house so that their twenty nine year old son, and thirty two year old daughter could move back in.
Anyway, the other day TriCare sent me an EOB (Explanation of Benefits) saying I owed the doctor $400. This didn't sound right, and so I called them. First of all, understand that TriCare is a big bureaucracy just like MediCare or MediCaid. So I called and found out that even though I've been with them since 2008, they still thought I was covered under Blue Cross. Hence, they thought I had a primary and secondary insurance. Well, we set it straight, and then it was up to me to call the doctor's office and ask them to re-bill.
Okay, in other words, TriCare had no intention of sending a check to the doctor, even though they had his bill in their computer along with the proof of coverage and all the ICD-9 codes.. And that's how insurance works, kids. Even government run insurance!
So I called the doctor's office and spoke to their billing company. That's right. The doctor pays a billing company because the morass of insurers is so messed up, he has to get it out of his office so that he can focus on medicine. She thanked me for calling, and confirmed she would re-bill.
Mind you this puts this account in the 30-60 day column or perhaps even the 90+ day column. Imagine your plumber putting up with you not paying a bill right away.
So my doctor will re-bill $400, include all the attachments and codes, send it in and wait. Tricare will pay him 21% of that, because this is what MediCare is paying out now, and TriCare falls along those lines. Icky. Right? I mean, do you see the absurdity in this? There's the administrative end on his side, the administrative end on the insurers side. It's no wonder why so many physicians are bailing out of government run programs, as well as some HMO and PPO contracts all together.
So, I'm going to take actual figures and show you how much government insurers paid for surgeries ...well after the 0-30 day period in 2009.
Medicaid: Billed 1007.00 (lifesaving operation) Paid 167.91 (service given and billed in 2003, paid 6 years later).
Medicare (paid by a government contracted provider): Billed $1839.40 (lifesaving operation) Amounted Rejected: 1442.54 Amount approved and paid: $ 396.86.
As for what's being billed and the amount they allow? I've covered that here explaining the incredible shrinking machine.
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i am truly sick over this healthcare mess. and mess it is! what are they thinking? we don't want it and they don't care. have they lost their minds?
ReplyDeletesigh... bee
xoxoxoxoxoxo
It's been a mess for a real long time, and this wasn't real reform.
ReplyDeleteI do think there needs to be provisions made for the poorest in the nation, however, I question the way it's routed through the health care insurance industries in many communities, which this will do also.
and we have idiots that think the government can be our nanny....
ReplyDeleteI'm thinking this....
ReplyDeleteMedicaid and Medicare only for the poorest in our nation. Those two should be direct payer systems and rather than running the programs through the private health insurance agencies, take their contracted role out of it all together.
Let the health care insurance agencies deal with the rest. By eliminating 2/3 of their business, they'll be forced to come up with affordable options for those who can't come up with the $600/ month for premiums. And really, more people need to be aware of their crazy salaries and compensation, as well as their bad practices, and let the public push them for reform.
In addition, physicians can start playing up their cash rates. Hospitals too. There is no reason insurance companies should have an assumed monopoly on care.
Would this work? It has a better chance than anything else.