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Hospitals are having trouble making money. Funding for statutory mandates to provide treatment to poor people in hospitals, such as in emergency rooms, is apparently in limbo with the pending Federal Healthcare Reforms. See, for example, the post on February 9, 2010 on Insurance Claims and Issues Web Log.
Health Insurance Companies are reportedly making it easier for the billing departments of physicians' offices to check on whether a prospective patient has Health Insurance Coverage which of course makes it more likely that the physicians' later bill will be paid by someone, and also to check on whether a Health Insurance Claim for a given patient's procedure has been covered or Denied by the Health Insurer. In the Fall of 2009, a number of Health Insurers acted in together to offer one Internet "portal" to physicians and hospitals in Ohio in a pilot project, so that the physicians' and hospitals' billing departments might check on patients' Health Insurance Coverage status.
Last Fall's pilot project in Ohio is now reportedly being extended to New Jersey. "Doctors will be able to check instantly whether a patient has coverage and be able to track the status of the claims." Reed Abelson, "New Jersey is Added to Trial Program to Streamline Health Insurance Paperwork" p. B4, col. 1 (New York Times Nat'l ed., "Business Day" Section, Thursday, February 11, 2010). New Jersey Health Insurance Companies and Plans reportedly include Aetna, Amerihealth New Jersey, Cigna, Horizon Blue Cross and Blue Shield of New Jersey, and United Healthcare. Id.
Physicians quoted in the linked newspaper article are happy with what they see as a "better" system. Id. Recall, however, that anecdotal evidence from the Kansas Insurance Commissioner has it that 50% of Health Insurance Claim Denials are overturned on intra-Company appeals in that State. See the post on Insurance Claims And Issues Web Log on February 11, 2010.
To put it another way, based on the Kansas experience, Health Insurance Companies and Plans change their minds and provide Coverage for previously denied Health Insurance Claims over half the time when the patients appeal the denial. Suppose a billing department employee at a physicians' office or at a hospital accesses the portal to track the 'status' of Coverage for that patient's Claim, before the patient appeals the Denial? She or he would see that the Claim was Denied, that there is no Coverage according to the information in the computer, right? Billing department employees are paid to see that medical bills are paid. Their job description demands that the identity of the party paying the bill is less important than seeing to it that an unpaid medical bill is paid.
Who among us has been to a physicians' office or to a hospital in recent years, Heaven forbid, and has not received a medical bill from the billing department announcing that the Health Insurer has paid nothing on their bill and the patient is still responsible for paying 100% of it?
Does it not seem likely that the same employee, armed with the apparent knowledge that a Health Insurance Claim has been Denied -- according to the up-to-the-minute status of 'Coverage' revealed by the Health Insurance Company -- will ask or suggest that the patient negotiate a payment scheme so that the bill gets paid? Perhaps a shared payment from the patient and the Health Insurer, to the vendor? If so, the vendor may end up being paid more than if the patient defaulted on the bill, but less than the face amount of its bill, while the patient may end up with less than the full Coverage to which the patient may be entitled and be out money the patient never had to pay, and the Health Insurer -- which conveniently supplied the Internet information to the vendor in the first place -- pays less than its full Coverage for the procedure?
It is understandable why physicians and their billing departments can be quoted as saying that it is "better" to track their patients' Health Insurance Coverage status online, regardless of which Health Insurer issued a Policy or Plan which should provide Coverage to the patient. It is "better," for them that seek to get their bills paid. It may also be "better" for the Health Insurers.
It is decidedly NOT "better" for the patient. Time could be much better spent by Health Insurers than by providing Internet portals to vendors to track Insureds' Health Insurance Coverage and Claims.
Please Read The Disclaimer.
That is all fresh info for me. Indebted to you for having posted it.
Posted by: Personal Injury Compensation | September 14, 2011 at 10:54 AM