Pressure from all sides

The last of the LA Times’ three-part series on the health industry yesterday centered around insurers’ aggressive and willful denial of claims from providers.
This practice means providers — rather than giving medical care, billing for it, and then getting paid — have to spend lots of money, time, and hire extra staff to chase down reimbursement from insurance companies.

It means that insurance companies hire lots of staff for the specific purpose of denying claims submitted by doctors and hospitals, who have already treated patients.

It eventually means that some providers — like Centinela hospital (in the story) go out of business.

“Insurers have found a very creative way of denying, delaying or slowing payments in a way that is having a real impact on patient care and some of our survival,” said Von Crockett, Centinela’s chief executive. “Every single doctor and hospital is writing off money they are legally owed but don’t collect. It’s an insane situation.”

And just when you thought it couldn’t really get any worse……

PR newsire reports that providers are also feeling them impacts of the newfangled Consumer Directed Health Plans on their bottom lines. With many consumer-directed health care plans, consumers are on the hook for more of their care. Premiums for these plans tend to be cheaper. In exchange, co-pays, co-insurance and deductibles are high. The study suggests that billing offices will need to revamp the way they do collections in order to get the money their owed.

Sadly, for consumers, it looks like we lose in all this. Insurance companies will continue to get their premium dollar. Providers will bone up on their collections savvy. And consumers will be chased into courthouse for collections.

Health Access California promotes quality, affordable health care for all Californians.

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